New Dentist Summer 2014 by The New Dentist

THE #1 JOURNAL FOR NEW DENTISTS

A superior student does not necessarily mean a successful dentist.

Dr. Michael Rethman

PLUS Demographic Character Should Determine Practice Model Screw- or Cement-Retained Implant Restorations SUMMER 2014

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FROM THE PUBLISHER’S DESK

SUMMER 2014 PUBLISHER

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Dear Readers,

Picante Creative http://www.picantecreative.com

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

Tess Fyalka Tess@thenewdentist.net

MANAGING EDITOR

hen it comes to creating the practice of your dreams, many dentists have a particular model in mind. Perhaps you want a high-end boutique practice, or maybe you believe an insurance-based family practice is the best choice. As Scott McDonald reminds new dentists, the type of practice you wind up with is often dictated by where you choose to practice. Turn to p. 10 and find out what he recommends when it comes to creating the practice of your dreams … not someone else’s. Did you know that if you accept dental insurance, you, not the practice, must be “credentialed”? Melanie Miller-Aranda explains this often confusing and complicated process and precisely what all those acronyms mean on p. 6. As your insurance-based or fee-for-service practice grows, patients will demand more options when it comes to replacing missing teeth. New dentist Dr. Fernando Padron, along with Dr. Sergio Rubinstein and master ceramist Toshiyuki Fujiki, share their experiences as well as the pros and cons of screw-based vs. cement-based implant restorations. Also in this issue, dental research scientist Dr. Michael Rethman emphasizes that a successful dental career requires far more than intelligence and classroom success. Discover what he believes many of today’s new dentists need to improve in order to achieve both personal and professional rewards. Finally, be sure to visit The New Dentist™ website at www.thenewdentist.net; take a moment to explore. In addition to regular practice management and clinical blogs, you’ll discover a wealth of FREE information and materials to guide you at every step throughout your dental career, as well as hundreds of FREE continuing education opportunities using interactive web-based training provided by Viva Learning™, an ADA CERP provider. Fondly,

Sally McKenzie, Publisher

New Dentist™ Advisory Board

Dr. Josh Austin San Antonio, TX UT San Antonio Dental School 2006

Dr. Charley Cheney III Dr. Katie Montgomery Newnan, GA Marysville, OH Tufts University School Ohio State College of Dental Medicine of Dentistry 2004 2006

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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 U.S. dollars only). Copyright ©2014 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.

Dr. Kevin Rhodes Round Rock, TX UT San Antonio Dental School 2005

Dr. Mary Shields Louisville, KY University of Louisville Dental School 2011

Dr. Jared Simpson Bakersfield, CA UT San Antonio Dental School 2005

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TABLE OF CONTENTS

SUMMER 2014

FEAT U R ES

6 Accepting Insurance?

You Must be ‘Credentialed’ By Melanie Miller-Aranda

8 Don’t Let IT Costs Burn Your Practice By Dan Edwards

10 Demographic Character Should Determine Your Practice Model By Scott McDonald

14 Brighter Smiles, Bigger Profits 16 Top 5 Fixes for Patient Reviews 20 Screw-Retained or CementRetained Implant Restorations By Fernando J. Padron, DDS; Sergio Rubinstein, DDS; Mr. Toshiyuki Fujiki

26 What is MacPractice Doing for Today’s New Dentists?

28 A Superior Student Does Not

Necessarily Mean a Successful Dentist

30 First Evidence-Based

Diagnostic Criteria for TMD Developed by SUNY Dentist

36 D EPARTMENTS

2 Publisher’s Message 36 Skinny on the Street 36 Index of Advertisers

4 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

ADA APPS FOR CODING AND PATIENT EDUCATION!

CDT Code Check App for iOS and Android

The Chairside Instructor App for iOS

Toothflix 2.0 App for iOS

Get CDT 2014 codes in the palm of your hand with the new CDT Code Check app. The App contains the most up-to-date CDT Codes, including 29 new procedure codes, 18 revised procedure codes, and seven changes to subcategories and their descriptors. CDT Code Check is now a subscription-based service. As soon as the 2015 CDT Codes are released, you will receive an automatic update inviting you to purchase the new version while keeping the code sets from previous years. The ADA is the official source of the CDT dental procedure codes.

On an iPad, the Chairside Instructor looks even better! Impress your patients with crystal-clear graphics using the newest technology. Find images in a flash with the category list, keyword search, or Favorites feature. You can even draw on a picture, add a comment, email it to a patient, and save it for future use! See adacatalog.org for details and a demo. Currently available for Apple devices only. Order from adacatalog.org, and then complete your download at the Apple Store. The app is available for iPad and iPhone in English only.

If your practice uses iPads in patient care, Toothflix 2.0 is the educational app for you! The app includes all 26 of our updated Toothflix 2.0 videos, intuitively arranged for quick access. Email videos to patients before or after a consult; mark your favorite videos or even the exact video clips you show most often. The â&#x20AC;&#x153;last watchedâ&#x20AC;? feature makes it easy to retrieve the videos you use most. Internet connection required to use the app. Currently available for Apple devices only. See adacatalog.org for complete product specs and to place your order. Then, complete your download at the Apple Store.

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Visit adacatalog.org to purchase The Chairside Instructor and Toothflix 2.0 Apps for iOS. To purchase the CDT Code Check App for iOS and Android, visit iTunes or Google Play online.

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Accepting Insurance?

You Must be ‘Credentialed’

BY MELANIE MILLER-ARANDA

Network Provider” with most plans. Even dentists with malpractice issues can often become In Network Providers. The process, however, may take a bit longer, and it is based on the severity of any malpractice case(s).

SHOULD YOU CHOOSE TYPE 1 NPI OR TYPE 2 NPI? NPI stands for National Provider Identification number, and one of the most confusing decisions for the dentist is choosing between a Type 1 NPI versus a Type 2 NPI. A Type 1 NPI is required if a dentist is putting his/her Social Security number on the dental insurance claim forms and is a solo practitioner. Whereas both Type 1 and Type 2 NPI are needed if the practice’s name and Taxpayer Identification Number, also known as TIN, are used for billing purposes. If the dentist owns multiple locations, billing under separate TINs, an additional Type 2 NPI is needed for each office. You can find additional information on Type 1 and Type 2 NPI at: • https://npiregistry.cms.hhs.gov/NPPESRegistry/NPIRegistryHome.do • https://nppes.cms.hhs.gov/NPPES/Welcome.do

WHAT’S YOUR UCR? The next step in the process is to establish a “Usual Customary Rate” (UCR) for your practice or evaluate your current one. A UCR is the charge for dental services that is consistent with the average rate or charge for identical or similar services in a geographical area. It is vital to be competitive within your own ZIP code and specialty. You will know if you are competitive when requesting a fee schedule analysis, you will be given percentages to choose from. This can be requested through companies such as McKenzie Management. Your UCR should be billed on all claim forms to all dental plans, regardless of your participation. In doing so, you are telling the dental plans that this is the fee you charge for each procedure. This will help to create a Reasonable Customary Rate (RCR) for your area that will benefit the entire dental industry. Once you have become an In Network Provider, you will be listed in the dental provider directories. Patients utilize their dental plan directories to look for dentists close to their home or work to obtain the In Network insurance benefit. They have the capability to search the Internet for their plan’s participating providers by ZIP code, name, or specialty. If your name does not appear on this listing, it will make it more difficult

id you know that to participate in insurance group plans, you, the dentist, must be “credentialed”? Credentialing is a contract that is between a dental plan and the individual dentist, who agrees to comply with the terms of the agreement and accept the fee schedule(s) offered. A dentist can apply for participation when s/he has a license in the state where the doctor is interested in becoming an “In Network Provider.” To become “credentialed,” you will be required to provide several documents, which credentialing experts can help you identify.

CONTINUED ON PAGE 32 >>

WHO IS CREDENTIALED? Keep in mind that a “group” is not credentialed, rather the individual dentists are. If a dentist is credentialed at another location, in most cases his/her credentialing will not transfer from one office to the next. The doctor’s participation is based on the TIN or Employer Identification Number (EIN), the physical office address, and the doctor’s dental license. If any one of these changes, the doctor is considered to be an “Out of 6 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

Melanie Miller-Aranda is co-owner of Insurance Credentialing Specialist. Her experience in working with startup practices and existing offices has given her a passion to assist dentists with optimizing their practices and increasing profitability through credentialing. She can be reached at (561) 422-9938 or contact@InsuranceCredentialing.com. For more information, visit www.InsuranceCredentialing.com.

Don’t Let IT Costs

Burn Your Practice

he future, it appears, will simply give you more and more technological tools with which to connect and evolve how you do business and interact with your patients. The technology you use to run your practice has to be used, maintained, and supported properly to keep the practice operating smoothly. If you take a moment to consider that so many are so willing to spend large amounts of money on their computer systems to store, access, and transmit information, the value of that information becomes more apparent as well. And because information has become so useful, it’s not only the equipment that demands protection, but also the data. Every day, IT companies are paid a staggering amount of money for services that could have been avoided with proper planning and budgeting. Controlling your IT costs cannot be done by constantly fighting fires. Consider the points below to determine if you’re doing all you can to advance, protect, and monitor your network.

infrastructure each year or get onto a HaaS program (Hardware as a Service). According to an Intel study, small to medium-sized businesses trying to extend PC lives beyond three years face more virus attacks and system failures as well as higher maintenance costs, not to mention the additional downtime. Whereas upgrading within three years can keep overall spending down. Do the math; you may be quite surprised what little is needed to budget each year to be running smoothly at all times. The ideal way to refresh your infrastructure every three to four years is through HaaS. This allows you to make one payment for your infrastructure, antivirus, backup, and support in one predictable monthly installment. •

COMMIT TO STAYING CURRENT WITH SOFTWARE RELEASES – Get on the latest release

(once it’s determined stable) and stay current. By doing so you will realize an increased value from your initial software investment. There are always costs associated with supporting an older release, and inevitably something will come along that will require you to upgrade, whether it be the introduction of a new operating system, HIPAA directive, or new insurance structure. Remember, old computers with new software run slowly.

STAY CURRENT •

BY DAN EDWARDS

REFRESH YOUR PC FLEET – Computers should be

replaced every three to four years to keep costs down. All systems degrade over time and age in dog years. From the beginning, budget to upgrade 30% of your •

STAY ON SOFTWARE SUPPORT – This goes hand

in hand with staying current on software releases. Often software upgrades are included with the purchase of yearly support. As soon as software is purchased, there is already a newer software version in the works with innovative features using the latest technology. Your hardware should be built to enhance the software you utilize. You cripple your software capability (and yourself) without aligning with the proper hardware to run it. Oftentimes your IT company will need to work with your software support to remedy issues. When you don’t have software support, it can quickly become costly. CONTINUED ON PAGE 12 >>

Dan Edwards is CEO and founder of PactOne. He can be reached at dan.edwards@pact-one.com or by phone at (702) 375-4017 direct, (866) 722-8663 tollfree main number.

8 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

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Demographic Character Should Determine Your Practice Model

ike it or not, for good or for ill, every practice has a distinct brand and unique practice model. But this brand and model do not exist in a vacuum. They should reflect the population the practice serves. Will any type of dental practice model work in any location? Not at all! The practice model (and brand, and range of services) must match the population to thrive. Not doing so is an invitation to competing practices to fill the void of patient wants and needs. We know a dentist who wanted to promote a PPO- and HMO-type practice in a location that was extremely affluent. Everyone loves a discount dental clinic, right? Research and experience indicate that this was the wrong practice model for the area. Large numbers of local residents shunned the office as being “for poor people.” Another dentist we know wanted to provide only high-end, fee-for-service dental care in a community that was extremely poor and undereducated (and underemployed). He was working under the assumption that patients always want “the best care possible” and would be willing to pay for it if they only knew. The hard, cold reality is that a practice model must match the demographic character of the people the doctor wants to reach, who can be influenced by what the practice is perceived to offer. That is why a “one-size-fits-all” practice model just won’t work. Practice models fill a spectrum of services and perceptions. The ones that are successful will do the research necessary to know how large their potential patient base can be. As an example, if a practice wanted to open a multispecialty office that would include all the bells and whistles associated with a practice of this type, there would have to be sufficient numbers of patients to serve as a base for all these services. Specifically, the patients who seek out an orthodontist are a different type (or demographic character) than those who go to a periodontist. Their age, income, and education will likely be different. The variations in services, fee structure, location, and promotional activities should match the community, or the practice will not do as well as it should, or could fail outright. The same is true of general practices. 10 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

BY SCOTT MCDONALD

We see this happen in practice transitions all the time. An otherwise profitable practice that is doing reasonably well in growth will be purchased by a professional who wants to radically change the image and structure of the practice to match his or her tastes and preferences rather than fully considering what made the purchased practice successful in the first place. We are not saying that the new owner cannot improve upon what made the former owner successful. But it is foolish to ignore the underlying factors that made the practice successful. Good sense suggests that if a new owner wants to change the “market position” of the practice, it be done only after an examination of two primary aspects of the practice: 1. The “brand” of the practice that has made it successful (or which might be inhibiting its growth). 2. The demographic character of both the patient base and the community at large. Sometimes we find that the former owner has been occupying a niche (or smaller subset of the general population) that differs from the majority of the community. As an example, if the seller was deeply involved in his church, it is likely that the practice will draw a disproportionately large percentage of its patients from that congregation. If the buyer is not of that same congregation, he or she may be in for a surprise. Similarly, if the practice was relying upon a single employer, ethnic/language group, or neighborhood where they live, the same thing must be considered. One needs to look at the community as a whole to get an idea of the state of the demographic character of the larger, non-practice-affiliated patient base. Matching the demographics of the area to the practice is necessary when the community Scott McDonald is president of Scott McDonald & Associates and Doctor Demographics, LLC. He is an expert on site selection and practice promotion strategies for professional practices. His services are available at www.DoctorDemographics.com or by calling (800) 424-6222. Look for his podcast on “The Perfect Place to Put a Practice” on iTunes.

For Your Eyes Only. is changing (or not changing in a normal way). Recently we noted that due to the housing crisis, many people who would normally have moved from a neighborhood when they retired had to stay far longer than they intended because they couldn’t find buyers. This had the effect of making the median age of the residents older and older. The number and percentage of adolescents had dropped significantly. The closing of large employers can also displace or change the demographic character very quickly. That is what we mean when we say that people are “a moving target.” The same thing can happen when a new housing development or shopping center is constructed that influences the demographic nature of the community. It can all happen for the better or the worse in a short period of time. The population and economic trends in the United States are far more volatile now than in years past and will potentially continue to change dramatically. The successful practice must be flexible enough to adjust to the changing demographic character of its community to take advantage of the opportunities such changes bring and to adjust to the challenges that will be inevitable. What worked yesterday may be obsolete tomorrow. Therefore, knowing current trends in the demographic character of your practice area always helps you make better practice management decisions.

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WWW.THENEWDENTIST.NET

IT Costs

able than ever. Examine your current backup solutions against all possible catastrophic events (human error, hardware failure, theft, fire, natural disaster, or other data disaster) and truly assess how long it would take for you to recover and be back in business for your patients. This is most definitely not the place to make assumptions. TEST IT!

continued from page 8

PROTECT YOUR PRACTICE — REDUCE VULNERABILITIES •

INTERNET SECURITY – As tech-

nology is exposed to the Internet, your databases that store all of your patient information are increasingly exposed to security threats. This should be an iron-clad setup. A managed business edition antivirus advanced content filtering and a firewall should be utilized. They should use minimal resources, be fast scanning, and have accurate detection without needless interruption. Remember, if it’s free … it’s not for you! Free antivirus is either a gimmick to purchase or malware. A firewall truly has different layers

•

MAINTENANCE – An IT

company that understands the needs of a dental practice should be appointed to oversee system

maintenance, allowing IT professionals to improve efficiencies, increase performance, reduce risk, and manage growth. It allows proactive action to avoid costly downtime. With some IT companies, you have a team of experts administering the managed services solution, not just one. It is important to note that not all managed services plans are identical. An IT company maintaining your network through managed services should create efficiencies and automated fixes to keep you up and running and require very little of you. Speak to your IT company; some are equipped to accommo-

Controlling your IT costs cannot be done by constantly fighting fires. of protection. It examines incoming data (via the Internet) to determine its source and content, concluding if it’s legitimate or dangerous. Firewalls allow you to customize these parameters, giving you control on not just who can use your Internet connection, but where they can go, which minimizes access to websites that are prone to downloading viruses and malware. •

IT’S TIME TO BREAK UP WITH YOUR TAPE – The advance-

ment in technology over the last year with regard to data backup solutions is amazing. It’s not just about the backup but also speedy recovery. In the event of a hardware failure, there are affordable virtualization solutions that could have your entire practice up and fully functioning again in 60 minutes or less. If you still utilize tape or external backup drives, it’s time to leave them behind and move on. Virtualization and cloud solutions have become more afford-

12 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

use, maintenance, and ongoing improvement. A properly maintained computer will provide you with substantially higher speeds and minimize costly repairs and downtime. Keep the inside of those computers clean!

MONITORING YOUR PRACTICE — OVERSEEING TECHNOLOGY •

Not everyone is familiar with managed services, and it is not the same amongst IT companies. Unfortunately this creates confusion and often requires more research. Most managed services solutions tend to offer 24/7 monitoring, notifications, alerts of imminent hardware failures, print services, and proactive maintenance. It is important that the plan be an “all in” arrangement, which means you only pay for new installs and not any other service. A complete proactive managed services program can eliminate many of the tedious manual tasks associated with IT

date this service or will point you in the right direction. What would it be worth to learn that you had an imminent hardware failure that was recognized AND resolved before you even knew you had a problem? Whatever the future holds for technology, our ability to effectively use advanced tools only matters to those we serve when they feel more of a connection. The ability to communicate your sincere attention is what will make you stand out and is what will make the tools of the future really work. This is just a guideline to follow to ensure your time is spent enhancing your patients’ experiences each day rather than dealing with costly downtime because of inadequate planning and budgeting. Moreover, ongoing training and support must be provided to all personnel. Once these areas are instituted, it is more likely there will be a dramatic difference in the way your practice operates. Call or email me to discuss what should be included in your support agreement or managed services plan.

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People want to improve their smiles, and the market for related products is growing exponentially. Are you doing all you can to provide elective treatment options, such as whitening, for patients? According to a survey done by the American Academy of Cosmetic Dentistry, virtually all adults – 99.7% – believe a smile is an important social asset. Your patients are constantly reminded about perfect smiles and whiter teeth. And it’s no secret that Americans like to look good. In fact, procedures in cosmetic dentistry have increased 300% in the past five years.

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peaking of looking good, last year, The Huffington Post conducted a survey and found that women alone invest more than $426 billion a year on beauty products. And when it comes to whitening, they want your opinion and your recommendations. Dr. Nathaniel Hill of Central Dental Comprehensive Dental Care is a new dentist in Maumelle, AR. This 2011 graduate of the University of Tennessee College of Dentistry has found whitening to be an essential patient service. “Being able to meet the needs of our patients is very important. Whitening treatment is a valuable tool in my practice. The value comes from making cosmetic dentistry accessible to everyone. You would think whitening would be very well known and understood by the consumer, but it’s probably the number-one question I receive during

Dr. Jasmine Henville

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CONTINUED ON PAGE 32 >>

WWW.THENEWDENTIST.NET S1U M M E R 2 0 1 4 KHJ19647_ASP-162_StudentCareer_3.7125x9.925.indd Job Name: ASP-162_StudentCareer_3.7125x9.925

3/31/14 6:19 AM

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Top 5 Fixes for Patient Reviews Consumer reviews are great … if you’re the consumer. When you’re the one being critiqued, reviews aren’t just nerve-wracking – they can be downright infuriating. As a dentist trying to generate new patients, monitoring your reputation on patient review sites is critical. However, it is understandably disheartening when you are doing everything in your power to give patients the best dental care possible and still come across negative patient reviews. One of the most frustrating parts about the whole situation is that the reviews from dissatisfied patients usually boil down to issues that are completely unrelated to the actual dental care they received. Unfortunately, prospective patients don’t pay attention to why a review is negative — only that it is. To help, we’ve compiled a list of the Top 5 Fixable Elements that contribute to low patient review ratings. 1. Time spent in the waiting room. The occasional wait is inevitable, but keep in mind that long wait times are often the biggest complaint found in patient reviews. Plus, they set the tone of a patient’s overall experience. Starting out with a long wait puts patients on edge, which only makes

16 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

them more critical about other factors that may not usually rub them the wrong way. • Create a list that approximates the length of various types of appointments and use it when scheduling. Pay attention to what each patient is being seen for, and take care to block out the appropriate amount of time. • Don’t overbook; it’s understandable to want a gap-free day, but — without a little wiggle room — one chatty patient can cause a day-long problem. • To prevent late patients that increase wait times, it’s beneficial to send day-of-appointment reminder messages to help them remember. • Most importantly, if a patient does have to wait longer than a few minutes, don’t ignore it. Apologize genuinely, offer a beverage, and keep them engaged. Patient communication goes a long way! 2. Chaotic management. Your patients don’t want to feel like they are just one more ball being juggled by an overwhelmed office staff. Satisfaction soars when patients feel like they are your top priority, which means giving them attention and care without distraction. • Don’t scrimp on staff to save money – it isn’t worth it. CONTINUED ON PAGE 18 >>

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Top 5 Fixes •

•

continued from page 16

Clearly define which tasks belong to whom, always keeping one person in charge of in-office patient engagement. Keep office communication open so that nothing slips through the cracks – last-minute scrambles are obvious to your patients. Listen to the staff’s needs and take steps to give them the tools they need to work efficiently.

3. Unappealing office environment. First impressions have a lasting impact. A sanitary office is high priority, but patients don’t want to be in an untidy or unappealing environment regardless of how clean it may actually be. • Decorate! And no – posters of teeth don’t count. If needed, request a bit of help; even a small, unattractive space can be stylish with the right touch. • Old buildings can look dingy even when they’re spotless, so paint the walls and the molding frequently. Get new carpet. Replace things like doorknobs and blinds. • Instead of a noisy water cooler, consider a contemporary tray with flowers and a pitcher of fresh water full of fruit slices. • If all else fails, fall back on technology. Some comfy chairs and a nice television are always crowd pleasers. It may feel frivolous to spend money on ambiance, but it is worth the extra cash. Not only will it raise satisfaction levels, it will ease the aggravation of a longer-than-preferable wait time. 4. Unprofessional staff interactions. It’s easy to keep a professional air when interacting directly with patients, but keep in mind that they can still hear you when they sit down. In fact, they’re generally paying extra attention because they have nothing else to focus on. Positive, cheerful conversations behind the front desk can actually make your practice feel more comfortable for patients by helping you appear more “human.” Just make sure the interactions don’t detract from patient attention, have a negative air, or cause potential offense. New Dentist Magazine Library - The New Dentist,... http://www.thenewdentist.net/magazinelibrary/in...

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5. Failing to get (and listen to) their opinions. Here’s the thing: If you don’t ask a disgruntled patient how they feel, they’ll give their opinion anyway. Problem is, it won’t be you they’re giving it to! The best way to avoid a negative review is to rectify your patients’ concerns before they broadcast them. • Administer surveys. Surveys can be used for many purposes (like marketing), but they are a great way to check in on what patients want and how your staff is doing. Be as broad or specific as you like, but limit the number of questions to about 10. • If you aren’t getting feedback, try a new tactic. Post a link on your social media, include an incentive, switch to emails. • Do an in-office check-in. Be sure someone catches them on their way out and asks how their experience was. *Tip: Offering a sticker to little ones can give you a moment to touch base with parents. Plus, moms and dads often have a better opinion of people that take time to engage their children. Remember: when you do see negative reviews – and you might – respond to them in a positive, helpful manner. Prospective patients will care more about your proactive effort to make things right than they do about the bad rating itself.

Screw-Retained or Cement-Retained Implant Restorations BY FERNANDO J. PADRON, DDS; SERGIO RUBINSTEIN, DDS; MR. TOSHIYUKI FUJIKI

ALL PHOTOS COURTESY OF DR. FERNANDO PADRON

mplant dentistry is executed with the ultimate goal of replacing missing teeth to restore form and function lost due to caries, gum disease, and trauma to the oral cavity. Placing dental implants should be done very carefully and with considerable planning to avoid adverse outcomes. Currently, dental schools are teaching that “implant placement is prosthodontic driven.” The reason: Implant surgery is a pre-prosthetic surgery, and it must be performed to satisfy prosthodontic needs and indications.1 Without restorative indication, there is no rationale for the use of implants beyond the occasional use for orthodontic anchorage.1 With implant therapy, there are two phases involved: surgical and restorative. Both phases require careful diagnosis, evaluation, and planning. There are two types of fixation methods for implant restorations: cement and screw retain. Both methods present advantages and disadvantages. Cement-retained restorations allow more freedom for the implant position. Unfavorable angulation can be corrected with a custom abutment that will receive a cement-retained crown. This type of fixation method has been reported in the literature with lower incidence of porcelain veneer fracture and screw loosening when compared to screw-retained restorations. It is often claimed that these restorations are more esthetic, because the crown covers the access screw hole. (Figure 1) However, inadequate removal of excess cement at the time of cementation may introduce a severe complication – cementinduced peri-implantitis, which may cause the implant to fail.2 It has been reported in the literature that 80% of periimplant disease is a direct result of bacterial colonization of extruded cement. The problem with the cemented restoration is that we don’t have a good verification of whether we eliminate the cement or not, because on the X-rays we can only see mesiodistally and not bucco-lingually. The majority of the cements 20 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

advertised for implant crowns are not radiopaque. The only cement that is radiopaque and can be used is Tempbond. The other huge disadvantage of cement-retained implant restorations is the lack of retrievability. Screw loosening has been reported in the literature as one of the most common restorative complications. To access the abutment screw in a loose-cemented implant crown, the restoration needs to be removed. Generally, the friction created between the intaglio surface of the crown and the implant abutment when cement is added is too strong. It creates a “cold welding,” which compromises the implant crown removal procedure. Either the porcelain might fracture or chip or the crown needs to be sectioned and removed, which adds the lab cost of a new crown fabrication to the practitioner or patient. The implant can also be damaged in the removal process. This problem is very difficult to deal with. It is true that it is easy to work with cement-retained restorations and custom abutments to compensate for non-ideal angulation. But don’t you want to know how long it will take to rectify a problem? This is probably the most attractive feature of screw-retained crowns. The main advantage of the screw-retained restoration is the ease of delivery and retrievability without damaging the fixture or the restoration. Implant position will determine to a great extent what type of method of fixation can be used. The planning involved to place and restore an implant with a screw-retained fixation method is usually the same (or should be the same) as for a cement-retained crown. The steps are: anatomic wax-up of CONTINUED ON PAGE 22 >>

Figure 1: Cement-retained implant crown. Patient did not want to show the access screw hole in the occlusal table. Custom abutment and cemented PFM crown.

Figure 2: Implant planning. CBCT scan with radiographic guide. Guide shows the contour of the planned crown and the intended access screw hole. Modifications on implant angulation and angled abutments will be used in this case. Also bone graft procedures will be required at the time of implant placement.

Figures 3,4: Screw-retained implant crown. #7,10 screw-retained implant crown. Proper planning and excellent implant execution allows the access screw hole trajectory in the desired place.

Figures 5,6,7: Implant. Previous implant failed in #12 site. New implant angulation did not permit the access screw hole trajectory to come out from the occlusal table. Did not want cement involved on this case due to biologic compromise it might cause and the history of implant failure. It was decided to fabricate a screwretained crown using the palatal screw technique. Patient is a bruxer, so metalocclusal was recommended in this particular case.

continued from page 20 the missing tooth or teeth, duplicate of the wax-up, and then a suck-down fabrication, which will serve as a CT scan guide and a surgical guide. With the CT scan and the radiographic guide, we can determine the spatial relation of the intended crown and implant position in relation to the adjacent teeth on the arch and residual bone. (Figure 2) If the final crown is a screw-retained restoration, it will require a more precise implant placement with a surgical guide. This will ensure that the access screw hole trajectory comes out in the center of the occlusal table on posterior implants or at the cingulum for anterior implants. (Figures 3,4) There is another technique in which no matter the implant angulation, it can still be restored with screw retention and avoid the use of cement. A custom abutment is fabricated, and then a mini-screw is tapped coming always from the mesio-palatal/lingual to ensure direct access to it. A crown then is secured with the mini-screw of 1.25mm diameter. (Figures 5,6,7) Partial or full edentulism with the use of removable prosthesis can cause severe ridge resportion. Loss of the buccal

plate can be caused due to traumatic tooth extraction, endodontic abscesses, and advanced periodontal disease. Not all the patients will have a bone graft for socket preservation at the moment of extraction. These situations will create a challenge for the surgeon and restorative dentist when treatment planning implant-dentistry, due to the implant angulations. (Figure 8) Anticipated contours of the final restoration will vary if the crown is screw-retained. For anterior teeth it is preferable for the crown to be close to the cingulum and away from the incisal edge to provide proper substructure support. CONTINUED ON PAGE 24 >>

Dr. Fernando J. Padron received his dental degree from Central University of Venezuela and completed a three-year residency in prosthodontics and one-year implant fellowship at Nova Southeastern University, Florida, from 2008 to 2012. He is an active member of the American College of Prosthodontists and a diplomate of the International College of Oral Implantologists. He is a prosthodontist in the practice of Sergio Rubinstein DDS & Associates PC, Skokie, IL.

Toshiyuki Fujiki, RTD is a laboratory master ceramist in the practice of Sergio Rubinstein DDS & Associates PC. He has co-authored numerous articles and is an international lecturer.

Figure 8: A case that shows the challenge for the restorative dentist due to implant angulation. The surgeon had to angle the implants to take advantage of the minimum bone volume available on this patient. The laboratory support was paramount to restoring this case with the screw-retained fixation method.

22 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

Dr. Sergio Rubinstein received his dental degree in 1980 from the Universidad Tecnologica de Mexico. He completed his specialty training in periodontal prosthesis at the University of Illinois at Chicago, where he was an assistant professor. He invented a custom abutment to prosthetically correct misaligned implants. He is an international speaker, instructor, and author.

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Implant Restoration continued from page 22

This could result in a lingual bulky contour, but considering the advantages on the ease of delivery of the restoration and elimination of cleaning any excess of cement, would be more favorable than unfavorable. (Figure 9) For provisionalization to sculpt peri-implant tissue, surgical sites, and immediate load cases, screw-retained provisional restorations are preferred over cement-retained. (Figure 10) The screw-retained provisional restoration can gradually mold the tissue around the implant with gently applied pressure. Cement-retained provisional restoration is more technique-sensitive. A PEEK (polyetheretherketone) or titanium implant cylinder modified with composite material needs to be prepped and customized to receive a temporary crown. To avoid cement extrusion to the peri-implant tissues, a finishing line needs to be positioned supragingival, causing an esthetic compromise if the implant is in the esthetic zone. The indications for screw-retained restorations are the following: • Cantilever bridges – Whenever doing a cantilever bridge, this prosthesis should be screw-retained. If cement is used, it could be debonded over time. • When the patient has lost an implant – For a patient who has lost an implant, the incidence of failure rate for the second implant is higher. A screw-retained implant is preferred. • Opening of the mesial contact on implants adjacent to natural teeth – A screw-retained crown is indicated because it is easy to retrieve to close the contact adding low fusion porcelain or gold. • For long-term treatment planning and provisionalization – A screw-retained implant crown can be removed and a Figure 9: Screwretained restoration on a lower incisor. Slight overcontour on the lingual aspect.

Figure 10: Screwretained provisional #8 and for immediate load on full arches is preferred.

24 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

Figures 11,12,13: In immediate load implant procedures, screw-retained restoration is preferred over cement-retained prosthesis.

• • •

screw-retained provisional with a cantilever pontic can be added if the tooth adjacent to the implant site is lost. Immediate load. (Figures 11,12,13) Deep implants. 4mm of inter-arch space. Figure 14: Angulated

implants suggest a Indications for cement-retained cement-retained restorarestorations: tion. In our experience • Implant angulation. (Figure 14) we can restore any case with the palatal-screw • Esthetics demand access technique to overcome openings. extreme angulations. • Thin biotypes using zirconium abutments. • Limited jaw opening. It is very important that implant restorations are given careful prosthodontic planning before the implants are placed in the patient’s mouth. Once the implant has been restored, patients should be monitored regularly for maintenance and checked for bone loss, bleeding, and suppuration, irrespective of the type of implant fixation. Cement-retained restorations should be carefully assessed at each recall appointment due to the higher incidence of cement-induced peri-implantitis. When a problem arises, either prosthetic or surgical, a screw-retained restoration would require less chairside time to correct. Certainly there is no right or wrong choice when selecting one type of connection above the other, but clinicians need to be aware of the advantages and disadvantages of each type of prosthesis and make the appropriate decision based on the specific clinical situation.

References 1. Taylor Td et al. Prosthodontic considerations. Clin Oral Impl Res 2000:11 (Suppl.): 101-107. 2. Pette G, et al Radiographic appearance of commonly used cements in implant dentistry. Int J Periodontics Restorative Dent. 2013 Jan-Feb; 33(1): 61-8.

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What is MacPractice Doing for Today’s New Dentists? The New Dentist™ magazine recently spoke to MacPractice CEO Mark Hollis about what his company has to offer new dentists.

What is MacPractice? MacPractice is a client-centric dental practice management and clinical software development firm dedicated to the development and support of best-of-class native software specifically for Macs, iPads, and iPhones. MacPractice provides all necessary associated services for new dentists to successfully select, implement, and use MacPractice. What makes MacPractice different from other practice management software? Most new dentists are already Mac, iPad, and iPhone users, so they’ve already experienced the legendary ease of use and reliability of Apple products and the quality of service that has consistently made Apple number one in ratings by JD Power and Consumer Reports. MacPractice makes it possible for new dentists to operate every aspect of their practice using native Mac software that leverages Apple advancements in each new release of OS X and iOS, as only OS X and iOS native software can. This year Apple is celebrating the 30th anniversary of the Mac. Along with Apple, MacPractice co-founder Patrick Clyne and I have developed, implemented, and supported native Mac software in thousands of dental practices over the past 30 years. Over the last 10 years, MacPractice has developed an environment with interoperable apps for iPad and iPhone. MacPractice has collaborated with equipment manufacturers to provide a variety of quality Mac-native cameras, X-ray sensors, and panoramic, cephalometric, and cone beam products at a variety of prices from which new dentists can choose. Technology advances, but human beings remain the same. The more technology a new dentist wishes to utilize in a practice, the more services are required for a successful implementation. Based upon 30 years’ experience with thousands of dental practices, MacPractice provides all the resources necessary for successful implementation. With 120 highly experienced and caring employees in Lincoln, NE, and 40 MacPractice practice consultants throughout the U.S., we are dedicated to helping dentists select MacPractice and implement it in their practices. Apple is constantly innovating with new products and new operating systems. Unlike PC users, Mac users are enthusiastic to use every new Apple technology. As a 26 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

premier Apple developer, MacPractice tests and updates MacPractice electronically to ensure that MacPractice users can purchase and utilize the most recent innovations from Apple in their offices. (MacPractice also supports earlier versions of its software for dentists who are happy with what they have). Software development is in MacPractice’s DNA. MacPractice works with Apple business teams at Apple stores throughout the U.S. to assist dentists in the proper selection of hardware. Regional consultants also work closely with dentists in this capacity.

What does MacPractice have to offer new dentists? For new dentists who purchase a practice from another dentist, MacPractice’s data conversion team can extract data from an old system and migrate it into MacPractice DDS affordably, with little or no redundant data entry. The team has experience with conversion from most dental software. After determining hardware and software options and arranging for data conversion, it is time for on-site installation and training. MacPractice consultants do most Apple hardware installations, but they work with other consultants and IT professionals if the dentist requires additional assistance. However, it is quite common that some dental offices install their own Macs with MacPractice before the consultant arrives to train. After all, Apple creates Macs to be easy to set up. On-site training is without question the most effecCONTINUED ON PAGE 34 >>

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A superior student does not necessarily mean a successful dentist.

unning a successful practice involves far more than excelling in dental school. That may seem like an obvious point, but for many of today’s dental school graduates, the reality of that statement comes as a significant shock upon exiting the predictable confines of the classroom. Dr. Michael Rethman As Dr. Michael Rethman sees it, getting into dental school has become so competitive that it is drawing superior students, but not necessarily those who will become superior dentists. He is a board-certified periodontist, dental research scientist, and former director of the U.S. Army Institute of Dental Research, as well as past-president of the American Academy of Periodontology. Dr. Rethman notes that “Dental schools are attracting students who are very good at setting goals and getting good grades. Many of them have really high IQs, but their EQs (emotional quotient) are often lacking.” In other words, many dental students score well on tests, complete clinical requirements expertly, but have extraordinary difficulty relating to people. “In the dental practice, you’re in an environment in which you have to explain to people what they need. But the patient has to have the trust and the confidence in you to pay for that treatment.” Instilling that trust and confidence requires dentists to be able to sell themselves and their treatment plans. “Many young dentists emerge from dental school completely unprepared for the sales aspect of the profession,” notes Dr. Rethman. Dental schools are selecting very smart candidates, but they are not necessarily well-suited for private practice, he adds.

28 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

Trends common among the millennial generation are also becoming evident among dental school graduates. “Many students have an expectation that just because they graduate from dental school, the whole world is going to open up for them. That’s just not true. They need to recognize that when they emerge from dental school, they really don’t know very much at all. That shouldn’t come as a surprise.” Dr. Rethman urges new dentists to spend at least a year in an internship. “They need to work in an environment with a fully credentialed dentist whom they can go to for help before they go into private practice and they are the boss.” Dentists should look at the time as a fifth year of dental school. In terms of ongoing continuing education, he strongly urges new dentists to become better diagnosticians. “They need to know how to tell if a tooth needs a root canal; they need to understand periodontal disease. They need to know whether a carious lesion is likely to progress or not. They need to understand that you treat 20-year-olds differently than you treat 7-year-olds, and why.” Once new dentists gain greater experience, he urges them to purchase their own practices, but get help in the process, he cautions. “They need to be wary of paying too much money for blue sky, and recognize that the true value of the practice is moving into a place where another dentist has been successful. You are also getting a lot of necessary equipment at a discounted price. But you are not necessarily going to get many of the outgoing doctor’s patients.” He emphasizes that new dentists need to recognize that they are responsible for building their patient base. And essential to building a strong patient base is hiring quality staff, starting with the business employee. “If you can find a good front desk employee, pay her well, and keep her. And don’t stop there. Hire good employees all the time because the cost of training new employees is enormous, not to mention the time involved.” And Dr. Rethman cautions: “Do not get into personal relationships with anyone on your

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staff. Everyone knows what is going on, and it’s very disruptive. If the dentist falls in love with someone who works for him or her, that person can leave and the dentist can be in love with them while they work for someone else.” When it comes to marketing, doctors need to be able to promote themselves as maintaining the highest ethical standards and always putting the patients first. “They also need to be able to do quality work quickly. That’s why that fifth year of dental education is so important.” Additionally, he notes that staff should be marketing for the dentist. “They should want to market your practice because they genuinely believe you are good at what you do and they are proud to tell their friends to come to your dental practice.” Dr. Rethman reminds new dentists that life goes fast, and decisions you make today can affect you for the rest of your professional career. He urges new practitioners to avoid the trappings that can come with having “Dr.” before their name. “The recipe for wealth in America is to live below your means and save early and often. There are dumb things and smart things to spend money on. Dumb things are the Mercedes and deluxe-equipped office. Smart things are adequate insurance, including disability coverage.” Finally, Dr. Rethman urges young dentists to invest in their marriages. “I’ve seen so many colleagues over the years working into their 70s and 80s trying to pay for their third wife’s grandson’s Mercedes. Divorce will increase your life’s costs enormously.”

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First Evidence-Based Diagnostic Criteria for TMD

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n the past, diagnostic criteria for temporomandibular disorders (TMD), which affect an estimated 10-15% of Americans, have been based on a consensus of expert opinions and often reflect a shared clinical perspective. None had been rigorously tested by scientists, until now. Richard Ohrbach, DDS, Ph.D., at the University at Buffalo (UB) School of Dental Medicine, collaborated with a number of scientists at other universities to develop the first evidence-based diagnostic criteria to help health professionals better diagnose TMD, or TMJ as it is commonly known. This protocol, called the Diagnostic Criteria for TMD (DC/TMD), emerged out of a pivotal workshop in Miami five years ago, which Dr. Ohrbach led. The resulting criteria were published in the winter issue of the Journal of Oral and Facial Pain and Headache. Dr. Ohrbach, who is co-lead author on the paper, says that TMD has historically been a controversial set of clinical problems, and many views have emerged within the dental profession regarding the nature of the disorders and how best to evaluate and diagnose patients. “Legitimizing a problem that affects 10% of the population, in terms of having a diagnosable disorder, and over 50% of the population in terms of having transient symptoms that come and go on their own, is extremely important for society and health care delivery,” said Dr. Ohrbach. An international authority on aspects of jaw pain disorders, Dr. Ohrbach collaborated in 2011 and again in 2013 with other U.S. researchers to publish the largest clinical study of pain conditions and how they develop that has ever been done. These research findings were part of the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study, which followed 3,200 initially pain-free individuals for three to five years. The new criteria, supported in part by the National Institutes of Health (NIH), comprise an improved screening tool as well as formal evaluation methods to help researchers and health professionals, including dentists, more readily differentiate the most common forms of TMD and reach accurate diagnoses that are grounded in supportive scientific evidence. Although TMD is commonly considered a jaw problem, researchers have determined that most people with chronic temporomandibular problems also contend with other ailments. 30 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

In 1992, the Research Diagnostic Criteria for TMD (RDC/TMD) reflected this awareness. Those criteria were the first to integrate biological, psychological, and social factors into two distinct domains, or axes. “We designed Axis I to evaluate the physical diagnoses, while Axis II characterized the nature of a person’s pain, distress, and disability,” says Dr. Ohrbach. “The criteria were then translated into 18 languages and became the most widely used diagnostic system among TMD researchers.” In the early 2000s, the NIH’s National Institute of Dental and Craniofacial Research (NIDCR) funded a group of experts to lead the first comprehensive assessment of the criteria. The group found Axis I in particular to be less valid than previously thought, leading to a mandate from the TMD clinical and research communities to revise the criteria. The current criteria, the DC/TMD, emerged after the empirical part of the project (Validation Project: 2001-2007) CONTINUED ON PAGE 34 >>

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patient exams. Dentists need to educate patients to help them understand not all ‘whitening’ products are created equal. Being able to customize whitening treatment for our patients, whether it is speed of treatment results, concentrations of bleaching material, or protocols to decrease sensitivity, is what should set us apart.” Given the huge potential for patient interest in cosmetic services such as whitening, this is an ideal practice-building tool. Oftentimes, it simply begins with opening the conversation. While many patients would love to change something about their smile, not all will verbalize those desires without prompting. Why? Some are embarrassed, others are concerned that they are bothering you. And then there are those who just aren’t sure how to bring up the topic. Simply asking a few questions can open up a host of opportunities to educate patients on services that your practice offers. You might create a “smile assessment” form for patients to complete. This can be incorporated into the new patient visit as well as the recall visits. It can be presented when the patient checks in, or completed in the treatment room, or it could be available on your practice website. The questions help patients to think about how they really feel about their smiles. It shouldn’t be an exhaustive questionnaire, but it should get the patients thinking. If it’s conducted in the treatment room, you might hand the patient a mirror and have a staff member ask a few basic questions, such as: “Are you satisfied with the color of your teeth?” “Have you tried whitening before?” “If you could wave a magic wand, is there anything that you would change about your smile?” The questions simply help open the lines of communication. Ultimately, if the patients feel at ease and are encouraged to talk about their oral health desires, and if the practice routinely educates patients about advances in oral health and treatment options, conversations about making changes and improvements here or there are as natural and comfortable as discussions about that necessary filling or crown.

Insurance

continued from page 6 to attract new patients. Being listed as an In Network Provider is a great source of marketing for your practice, which could help fill empty chair time.

WHAT ARE YOUR OPTIONS? Credentialing is a specialty that has many aspects that could either hinder or help your practice. Although it is very time consuming, it is imperative that you analyze all of your options. If you are not sure how to pursue or don’t have the time to study and understand what is required to become credentialed, seek assistance from companies or organizations that can direct you through this process. 32 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

“With Arrowhead I was doing full arch dentistry my first year.” Dr. Cody Bauer, Mansfield, TX

And you can too!

Arrowhead Dental Lab and the Dr. Dick Barnes Group have developed a CE plan specifically designed to make new dentists more successful. Dr. Cody Bauer used this plan to more than double his income in his first three years of practice, and triple overall production in his office. Bauer says, “Arrowhead’s plan really works! It’s so easy, dentists don’t believe it!” Get the skills and support you need for success and keep your patients coming back by providing the latest in dentistry. Sign up today for Arrowhead’s New Dentist CE Plan by visiting our website at www.ArrowheadDental.com or by calling 1-877-358-0285.

Arrowhead’s New Dentist Continuing Education (CE) Plan:

Full Arch Reconstruction: Be one of the 30% of all dentists who can. • Everyday Occlusion: Common sense concepts and techniques that take •

dentistry to a whole new level.

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•

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MacPractice

continued from page 26

tive way to get a new practice up and running smoothly. MacPractice’s goal is for a new client to use MacPractice in day-to-day operation after the first full training day. Training practice management functions usually takes two to three days scheduled over one to four weeks. Clinical functions might take another day or so. Everything depends upon complexity and objectives. MacPractice’s consultant trainers have many years of experience training and consulting in many dental practices. Consultants can be an invaluable asset to a new practice for much more than training and often become friends to the practice. MacPractice’s 2014 CEHRT certification makes qualifying dentists eligible for as much as $64,000 in Medicaid and Medicare incentives. Contact MacPractice for more information.

What are some of MacPractice’s unique benefits? For a new dentist who wants a paperless and filmless office, MacPractice offers unique benefits with its interoperable apps for iPad. With Patient Check In, the patients clock in, and everyone in the office sees a change in the MacPractice schedule. With MacPractice Clipboard, patients register, sign release forms, provide their health histories, and take their own photos. With MacPractice iEDR, the dental assistant and dentist can record visit data and show X-rays to the patient. In addition, MacPractice DDS is multispecialty and multidiscipline. Therefore it is

TMD Criteria

continued from page 30 was complete and published. The next phase of the project was an international workshop held in Miami involving 35 experts from a wide range of disciplines, including dentistry, psychology, radiology, neuroscience, medical ontology, and patient advocacy. Now the DC/TMD criteria start with a refined version of Axis I, the physical assessment. If TMD is detected, the protocol moves on to newly crafted diagnostic criteria to

help practitioners differentiate among the common subtypes. “In field tests, the diagnostic criteria for painful TMD were found to have at least 86% sensitivity and 97% specificity,” explains Dr. Ohrbach. “Sensitivity refers to how well a test identifies a person with a given ailment, while specificity characterizes the ability to identify correctly those who are not affected.” Axis II, the psychosocial assessment, has a shorter version to screen patients in order to assess pain location, pain intensity, pain-related disability, psychological distress, degree

34 WWW.THENEWDENTIST.NET S U M M E R 2 0 1 4

well suited to new dentists who wish to leverage operational expenses with another doctor, for example, a pediatric dentist with an orthodontist.

What are the cost-benefits to running MacPractice? MacPractice allows dentists to connect to MacPractice from home or from a remote office and interoperates with numerous web services for eclaims, web registration, and automated reminders, etc. The use of MacPractice does not require a never-ending monthly subscription fee, and has proven to be least expensive overall. In fact, 98% of dentists today use a client-server solution like MacPractice because it is reliable, predictable, and they will not be “down” or slow due to Internet connection or performance problems over which they have no control. MacPractice is a native Mac client server solution. In offices with less than 25 simultaneous users, no additional dedicated server is required. Unlike PC solutions which require a PC server and for which IT services are typically retained on a monthly basis. Most MacPractice users spend less than a few hundred dollars a year on IT services, and many MacPractice users do their own IT work with guidance from the MacPractice technical support department. Simply put, MacPractice is the most flexible practice management software to run a practice. For more information, contact Mark Hollis at markhollis@ macpractice.com.

of jaw dysfunction, and presence of oral behaviors (such as clenching the teeth or bracing the jaw) that may contribute to the TMD. If more information is needed, a longer, more comprehensive version is available to better measure these same constructs as well as a few additional ones. All of these instruments have been scientifically validated. Dr. Ohrbach says the next step is a one-day workshop in June in Cape Town, South Africa, to explore the next set of research questions that pertain to patient evaluation and classification.“My colleagues at UB are also continuing

their work on the diagnosis of TMD. Werner Cuesters, Ph.D., is working on the next-generation approach to disease classification for TMD and orofacial pain – that of bioinformatics and medical ontology – using a lot of our TMD data,” says Ohrbach. “And Yoly M. Gonzalez, DDS, MS, is working on international training in support of the dissemination of the criteria. “Many people in the pain research community worldwide are very interested in what we are doing as next steps.” Information courtesy of the University at Buffalo School of Dental Medicine

SKINNY

on the Street PHOTO COURTESY OF AACD

The latest news on products and services for new dentists and their practices SmileSimplicity® Veneers

Your Smile Becomes You Website The American Academy of Cosmetic Dentistry (AACD) has launched a new consumer website, www.YourSmileBecomesYou.com. It is part of a new campaign to help educate consumers about cosmetic dentistry, encourage them in their pursuit to improve their smiles, and raise awareness of the importance of seeking out an AACDAccredited or member dentist for treatment. This website enables the consumer to learn more about the many cosmetic dentistry procedures in a consumer-friendly, fun way. It provides consumers with foundational information that will help them to have more informed conversations about their oral health with the right cosmetic dentist in their area.

This new, painfree veneer solution preserves sensitive tooth structure and results in a beautiful, naturallooking smile your patients will love. This ultrathin, marginfree option allows dentists to create the most advanced cosmetic restorations, while delivering maximum esthetic results with no pain. SmileSimplicity Veneers offer a number of different smile corrective solutions, including being placed over crowns to improve esthetics, providing permanent whitening, and covering worn teeth to strengthen them and prevent further wear. A SmileSimplicity procedure takes just two short office visits of about an hour each. For a free consultation, call (888) 543-1143 or visit www.smilesimplicity.com.

PHOTO COURTESY OF SMILE SIMPLICITY

BioHorizons® Partners with Core3dcentres® NA as Authorized Milling Center Core3dcentres NA is now recognized as a BioHorizons Authorized Milling Center for Custom Titanium Abutments and Hybrid Abutments. Utilizing genuine Laser-Lok® and non-Laser-Lok® abutments and BioHorizons components and materials, Core3dcentres will machine custom BioHorizons abutments to exacting customer specifications across North America. Future plans include a rollout of this capability to Core3dcentres locations around the world. All related Core3dcentres workflows have been fully validated by BioHorizons, including the use of Core3dcentres scan bodies by the technician and the dentist. For more information, visit www.core3dcentres.com, call 888-750-9204, or email InfoUSA@core3dcentres-na.com. PHOTO COURTESY OF CORE3DCENTRES

INDEX O F A D V E R T I S E R S Advertisers in this issue of The New Dentist have made it possible for you to receive this publication free of charge. Please support these companies. Contact information can be found below, or visit The New Dentist™ Resources at www.thenewdentist.net to receive information from more than one company. ™

Affordable Image.................... 11 www.AffordableImage.com/007 866-961-4412

Beutlich Pharmaceuticals....... 23 www.beutlich.com 800-238-8542

Freedom Fast Track................... 1 www.FreedomFastTrack.com 888-426-7781

American Academy of Implant Dentistry.................... 21 www.aaid.com/newdentist 312-335-1550

Brident Dental & Orthodontics........................... 35 www.brident.com/careers 888-256-9976

Henry Schein Nationwide Dental Opportunities............IBC www.dentalopportunities.com 866-409-3001

American Dental Association....5 www.adacatalog.org 800-947-4746

CareCredit................................ 27 www.carecredit.com/dental 866-246-6401

Live Oak Bank.......................... 25 www.liveoakbank.com/dental 877-890-5867

Arrowhead Dental Laboratory............................... 33 www.ArrowheadDental.com 877-358-0285

Carestream................................ 9 www.carestreamdental.com/ cs3500 800-944-6365

MacPractice............................ IFC www.macpractice.com/company/ events 855-679-0033

Aspen Dental........................... 14 www.AspenDentalJobs.com 866-748-4299

Colgate....................................... 3 www.colgateprofessional.com 800-372-4346

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

Bank of America...................... 31 www.bankofamerica.com/ practicesolutions Matthew Christie, 614-623-5768 Ali Karjoo, 614-403-8295

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New Dentist Website............... 11 www.thenewdentist.net Pact-One.................................. 13 www.pact-one.com 866-722-8663 Solution Reach........................ 19 www.solutionreach.com 866-605-6867 Viva Learning........................... 29 www.vivalearning.com Wells Fargo Practice Finance.... 17 www.wellsfargo.com/ thenewdentist 888-937-2321 Western Dental........................ 35 www.westerndental.com/careers 888-256-9976 Wood & Delgado Attorneys at Law....................................... 15 www.DentalAttorneys.com 800-499-1474 The New Dentist – New Dentist Resources, New ... http://www.thenewdentist.net/resources.htm

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