New Dentist Winter 2013

THE #1 JOURNAL FOR NEW DENTISTS

UNDER PRESSURE Finding Work/Family Balance

PLUS Finally Get Patients to Floss The Latest Research on Contemporary Permanent Cements WINTER 2013

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FROM THE PUBLISHER’S DESK

WINTER 2013 PUBLISHER

Sally McKenzie Sally@thenewdentist.net DESIGN AND PRODUCTION

Dear Readers,

Picante Creative http://www.picantecreative.com

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

Tess Fyalka Tess@thenewdentist.net

MANAGING EDITOR

W

hile most working professionals would assert that the busy season is year round, this time of year those demands are taken up a notch … or 10. Holiday celebrations, family demands, work pressures all seem to pile on for new dentists doing their best to do it all.

In this issue, we look at the challenges doctors face in these early years of practice, caring for young families, building new careers, buying new homes, and establishing new businesses. While there may be no escaping the demands, there are ways of dialing back the intensity and engaging in behaviors designed to channel the pressure into positive activities and actions.

Also in this issue, check out what one new dentist inventor is doing to get his patients and yours to floss their teeth. On p. 6, Dr. Tim Pruett explains how he’s taken the frustration out of flossing.

And on p. 12, this issue’s guru, Dr. Glenn Krieger, urges new dentists to chart their own courses for success, starting with a solid plan for where you want to be in the next 12 months to the next 10 years.

We are pleased to welcome a submission from the University of Tennessee College of Dentistry. As new dentists will attest, you face a host of challenging considerations when trying to determine the best materials to use in your practice. Turn to p. 16 and find out what this team of dental researchers has to say about the latest in contemporary permanent cements.

Also in this issue, meet Advisory Board member Dr. Jared Simpson and discover what makes the busy practitioner and father of four love his work and his life.

Finally, be sure to visit The New Dentist™ website at www.thenewdentist.net. 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 webbased 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

2 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

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 ©2013 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

WINTER 2013

FE ATU R ES

6 New Dentist’s Invention

Takes Blood, Pain and Aggravation out of Flossing

8 Dentistry Under Pressure:

Finding Work/Family Balance Tess Fyalka, Managing Editor

12 Guru Urges New Dentists: Get a Plan, Policies, and Pictures

16 A Compendium of

Contemporary Permanent Cements: Clinical considerations for the new dentist in selecting the appropriate permanent cement for indirect restorations Ashanti D. Braxton, DDS Mojdeh Dehghan, DDS James F. Simon, DDS, ME.d

6

20 To Refer or Not to Refer … an Oral Surgery Case

PHOTO COURTESY OF DR. TIM PRUETT

24 Meet Dr. Jared Simpson,

28 My HIPAA Notice is Revised, Now What?

Mary Beth Gettins, J.D.

30 New Dentist™ Board Member

D E PA RTM E N TS 2 Publisher’s Message 32 Skinny on the Street 32 Index of Advertisers PHOTO COURTESY OF EAGLESOFT

Advisory Board Member: Keep an Open Mind

Helps Establish Clinic

32 4 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

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NEW DENTIST’S INVENTION

Takes the Blood, Pain, and Aggravation Out of Flossing

D

r. Tim Pruett was frustrated. He and his team had tried everything to help patients understand why they need to floss. “We explain the importance of flossing. We go through the process of dental decay and dental disease and periodontal disease. We show clinical photos of cases treated in our office showing the damage from decay or periodontal disease. What we would find is that patients would be motivated to floss for two to three weeks.

Then they would stop,” he explains.

It is a constant struggle for dentists to get patients to make flossing part of their daily routine. “A lot of these folks require interproximal restorations; they have gingivitis or are struggling with periodontal disease.” So in 2010, this new dentist, a 2004 graduate of the University of Florida College of Dentistry, set out on a personal quest to address the reasons why patients say they don’t floss: It hurts. It makes my gums bleed. Floss gets caught in my teeth. I don’t like putting my fingers in my mouth. It takes too long. During a “staycation,” Dr. Pruett was tinkering in his dental lab. “I decided to try to come up with a device that would address some of the reasons patients give for avoiding flossing.”

Flossolution® was born. Dr. Pruett began testing the device in his practice. He soon became convinced that the product should be brought to the marketplace. From there he began taking necessary steps to secure a patent, develop prototypes of the device, identify the best engineers and product designers he could find, and build relationships with production facilities.

“I’ve learned so much about how the process [taking a product to market] works. It’s been somewhat stressful, but it’s been fun and completely worth it.” He acknowledges that it does require an investment of time and financial resources.

“It all comes down to passion. If you believe in what you are doing, and if you think that your idea, your product, your invention can make a difference, you don’t look at it as an expense. It’s an investment,” emphasizes Dr. Pruett.

In April of this year, the product was released as part of a “soft launch.” “We sold and distributed the product through 6 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

PHOTO COURTESY OF DR. TIM PRUETT

my office for four months. It was our opportunity to build, measure, and learn what our product would be able to offer our patients.”

Dr. Bret Zak, a 2006 graduate of the University of Florida Dental School, was one of the local dentists that Dr. Pruett asked to try the device and give feedback. “I think it makes flossing more fun. It’s faster and easier. To me, one of the worst things about flossing is having your fingers in your mouth. And a lot of people don’t like that, so they won’t floss.

This allows you to floss without putting your fingers in your mouth. It’s not painful to floss with this; it actually kind of tickles, which is a lot better than having it hurt.”

Dr. Zak says that his was the first dental office that Dr. Pruett pitched the product to. “My hygienist fell in love with CONTINUED ON PAGE 30 >>

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Dentistry Under Pressure:

Finding Work/Family Balance

S

TESS FYALKA, MANAGING EDITOR

chool debt, staff, kids, mortgage, staff, demanding patients, insurance companies, old equipment, new and expensive equipment, spouse, aging parents, staff, and the list goes on … no question, there are a multitude of stressors for new dentists. If you are like many of your colleagues, stress has become accepted as part of the day-to-day routine, looked upon as the “necessary evil” of the business. For some, it’s practically a badge of honor. For others, it’s the number-one reason why they would choose any other profession if they could.

According to the American Institute of Stress, study after study shows that job stress is the greatest source of stress for American adults. “In New York and Los Angeles, the relationship between job stress and heart attacks is so widely acknowledged, that any police officer who suffers a coronary event on or off the job is assumed to have a work-related injury and is compensated accordingly.”1 Dentistry has a long-standing reputation for being a pressure-cooker profession. After all, doctors are working backwards, upside down, and in a cave.

Compound that with difficult patients, challenging staff, and sometimes brutal schedules, and you have all the makings for professional burnout. Consequently, over time dentistry can become drudgery for far too many clinicians as stress manifests itself in loss of energy, low self-esteem, poor or no decision-making, costly mistakes, illness, accidents, and more.

This 2003 graduate of Baylor College of Dentistry is a general dentist practicing in Dallas, TX. She purchased her practice in 2006 from a doctor who was relocating to another state.

Within three years of purchasing the practice, Dr. Rau and her husband, also a full-time professional, became parents of two daughters, now four and five years old.

“I’ll be very honest, the first year in my new practice was pretty awful. I was new to owning a business, new to running a practice, and new to managing a team.”

She inherited a staff of five during the transition and her intent was to keep the staff intact. “There were issues with the team as some of them were not happy with the changes that I was making. They were used to how the previous doctor did things. The first year was a huge struggle.” Dr. Rau said she made a concerted effort to work with the staff, understand their concerns, and get them onboard. Yet Stress from Day One morale was sinking and stress was “In the early years of practice, there are soaring. “I was trying to hear what many parallels. Doctors are moving into or everyone had to say and do as much building their own offices. They are starting of it as possible because I was the families, purchasing homes, they may have new person.” In spite of her efforts, aging parents. There are multiple simultathe situation wasn’t getting any better. neous demands that can be very disrupDr. Rau was working to please the tive for new dentists,” explains Leadership staff rather than recognizing that as the Coach Nancy Haller, Ph.D.* owner, she should be setting forth the Dr. Ritu Rau knows all about the expectations, not the employees. “That’s stress of being a new dentist, taking over the benefit of running your own praca new practice, starting a family, and tice; you are the boss. I find in my work DR. RITU RAU managing the many struggles that the that dentists don’t stop and recognize RUNS TO RELIEVE STRESS. early years serve up in abundance. that they are in charge. They can make PHOTOS COURTESY OF DR. RITU RAU 8 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

changes,” emphasizes Dr. Haller.

After several months, Dr. Rau sought outside help. “I hired a consultant to help me. The consultant looked at the situation and advised me that the personality conflict was just too great, and if I were to expect long-term success, it wouldn’t happen with the team that I had at the time.” The consultant validated what Dr. Rau quietly knew. “At the end of the day, the team will make or break you as a dentist. I knew I had to have a team that supported me, and if one person on the team is not onboard, things will break down, regardless of my good intentions.” Two staff were dismissed and another left for family reasons. It was the breakthrough that she needed. While the next few years presented a fair share of trial-and-error opportunities, today Dr. Rau enjoys a successful practice with a stable team.

As many new dentists discover, the hiring process is critical to long-term stress management. “Taking the time to hire the right people can be stressful, but it will be worth it in the long run. You need people you can work with comfortably.”

Pay Attention to Stressors Dr. Haller reminds new dentists that while “stress is the spice of life,” what one doctor finds stressful another thrives upon. “Stress is not the same for everyone. There are some new dentists who love the idea of building their own operatories and choosing all of the new equipment and technology they will Dr. Nancy Haller use. For others, that can be extremely overwhelming. Dentists need to individually define what causes pressure.” Identify the causes of stress and address them.

Ironically, dentistry remains one of the very few professions in which the doctor and staff can have almost total control over the issues that cause stress in the practice, as well as how they respond to it.

Additionally, Dr. Haller notes that individuals who tend to be more expressive also are more willing to talk through those issues that cause stress. “That is one strategy for coping with stress. We are social animals, and being able to connect with someone you trust and tell them what you are experiencing can be very helpful in dealing with it.” Yet those who are not as expressive and are more introverted in their personality type can be more inclined to hold the stress in and not talk about it.

In dentistry, which is known to attract high achievers with perfectionist tendencies, those character traits can serve CONTINUED ON PAGE 10 >>

dentists well in many respects; however, they can become an Achilles heel when it comes to dealing with stress. “There is this attitude of, ‘I dare not tell anyone that I am struggling. Something must be wrong with me. I have to look strong and tough.’ This is prevalent in dentistry and among people with high needs for achievement. If you are an introvert, and you believe that acknowledging that you are struggling is a sign of weakness, you will not want to tell anyone. But it is the suffering in silence that really needs to be cracked.

Talking to a trusted colleague, mentor, professional coach, friend, or spouse may help.”

Finding an Outlet After her children were born, Dr. Rau began running. “That became an incredible stress reliever. I started in the gym, then I joined a running club. It was great because it was social, it was

motivational, and it was good exercise.

I had never run before, and now I run marathons.”

Dr. Rau also is a prolific writer and maintains a regular blog. “I really enjoy writing, cooking, and learning about how to use social media in my practice. I find that a lot of dentists are hesitant to make time for what they enjoy because they are afraid to lose production time if they take a vacation or even a day off. But it’s necessary to have time away to find balance with friends, family, and personal interests.

There were times when I was so physically exhausted with the infants that I felt like I had nothing to give. All I was doing was working and caring for my children; I had put everything else to the side. Now I have more responsibility, but I have a much better grasp of how I want my life to be because I have made time for these other things.”

Dr. Haller urges practitioners to

take time and give careful thought to what you really want out of life and work. “We are really conditioned to be going, going, going, but there are tradeoffs, and we have choices. Take time to understand what is important. What do you value, because this is what shapes your choices. If something is important to us, we make time. Dentists will say they can’t leave the office by a certain time, but if their child has a recital or a ballgame, they will get out of the office on time. Your decisions are made by what you value. Take time to consider what is really important to you.”

References: 1 Stress In The Workplace, Job Stress, Occupational Stress. Stress.org

*Dr. Nancy Haller is a leadership coach for McKenzie Management, a national dental practice management firm owned by the McKenzie Company, which also owns The New Dentist™ magazine.

1

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BEEN THERE, Done That

Guru Urges New Dentists: Get a Plan, Policies, and Pictures Dr. Glenn Krieger is a former full-time dentist and widely recognized expert on dental photography. He offers nononsense advice for today’s new dentists, starting with the creation of a plan, and not just any plan. This is a written plan for your life.

I

“

t’s important to come up with a plan for how you envision your practice 10 years from now and how you envision your life 10 years from now. Find a quiet place and write down what it is you want in your life for the next year, the next five years, and the next 10 years. Establish those short-term and long-term goals. Consider how you envision your practice, how you envision your team, what kind of care you will deliver, and how you plan to get there. You may not have all the answers right away, but if you have a pretty good idea of where you want to be, put it in writing.”

This graduate of the University at Buffalo Dental School, SUNY, readily acknowledges that the plan is dynamic and will need to be updated regularly as life often presents unexpected changes and challenges, but he emphasizes that maintaining your focus on where you want to take your career is essential.

Having a written plan is particularly important when considering purchasing a practice, explains Dr. Krieger.

“If your plan is to deliver boutique-level dentistry for a few patients a day, charging a reasonable fee, and working with the best labs, don’t buy an insurance-based practice.

Or vice-versa, if you want to deliver care to a lot of people according to an insurance-based model, don’t buy a highend boutique practice.”

Dr. Krieger knows all about what happens when you don’t purchase a practice that is in line with your vision. “I bought my practice in 1997 and was almost three-quarters of a million dollars in debt. I had a clinical coach come in and tell me in no uncertain terms that the practice I had just purchased was the wrong one based on where I wanted to be. He told me I should sell my practice because it was never going to be what I wanted.” Instead, Dr. Krieger worked hard, took hours upon hours of continuing education, and kept his focus on his plan. “Five years later I was working three-andhalf days a week and had turned it into the practice I wanted.

12 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

It didn’t happen quickly; it took years, a lot of hard work, and a tremendous amount of self-sacrifice.” Dr. Krieger stayed true to his vision for where he wanted to take his practice.

The plan serves as a compass of sorts for new dentists as they make major decisions throughout their careers and their lives. “You will face a lot of choices, and if you don’t have something guiding you in terms of where you want to end up, you’re not working with a roadmap and you can wind up anywhere, except where you want to be.”

Additionally, he urges new dentists to trust their ethics and their clinical instincts when it comes to clinical care for their patients. “If you are asked to do something, such as provide a service for a patient and it doesn’t feel right, don’t do it. It’s important to keep that moral basis as you move through life.”

Along those lines, Dr. Krieger cautions dentists to be wary of the siren song of “preferred provider” status.

“Following the easier trail of becoming an insurance-based dental practice and therefore abiding by rules and regulations that have nothing to do with the patients’ health is far and away the greatest challenge for new dentists. When they come out of school they are heavily in debt, and then they drop a half-million dollars or more on a practice, and they realize these insurance companies will help them pay the bills.

CONTINUED ON PAGE 14 >>

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continued from page 12 “It starts off with the idea that they will rely on insurance for just a while. But before they know it, they have a practice that is dependent on insurance. They don’t get paid what they want. They can’t use the lab they want. They can’t attend the CE that they want because they can’t take time off.” He emphasizes that taking insurance doesn’t have to be an “all-ornothing” arrangement. “Just have a plan for what percentage of gross volume will be from insurance.”

Hiring Policies In addition, Dr. Krieger urges dentists to give particular time and consideration to their hiring practices. He finds that many dentists, particularly those early in their careers, do not consider the steps that need to be taken to hire quality staff.

“There are practices out there that have the same team for 20 years and others that turn over staff every year. If you don’t know how to hire properly, there are companies out there that can help teach you how to hire properly.” From there, Dr. Krieger recommends that every new practitioner establish written policies and procedures. “How you perform every system in your practice needs to be written down so that it is clear how you do it. This ensures that everyone knows their role, there’s accountability, and there’s no guesswork about what the goal is for every process, from handling a new patient appointment to paying the bills every month.”

Dr. Krieger believes strongly that continuing education is the cornerstone to excellence in clinical practice. “It doesn’t matter what you are taking, just take a variety of courses. Become part of a study club. Develop a protocol for the number of courses you will take each year. Dentists are clinicians, managers, and entrepreneurs. They need to take courses in all three of these areas. I don’t think that general dentists should try to be masters of everything. Deliver good restorative dentistry. Figure out what your vision is and take courses to help you achieve that vision.”

Naturally, Dr. Krieger urges every dentist to use a camera in his/her practice. “If you want to pick the one thing that can change a prac-

“In 10 years, you can make a million dollars on a $2,500 investment.”

— Dr. Glenn Krieger

PHOTO COURTESY OF DR. GLENN KRIEGER

14 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

tice overnight, it’s a camera. If you invest $2,500 for a camera, and that’s on the high side, if it’s used correctly, people who have taken my courses tell me that they will see a $100,000 increase in revenue. They are getting 40x the return on their investment the first year, the second year, and so on. In 10 years, you can make a million dollars on a $2,500 investment.

Use your clinical camera properly and be a great restorative dentist, and you can make a ton of money.”

While Dr. Krieger says that he is a fan of SLR (singlelens reflex) cameras, he urges dentists to simply start taking pictures. “I would tell anyone, I don’t care what camera you use, just start taking pictures. You’ll figure out what’s good enough for you and what isn’t. Learn how to take great images; there are a million resources out there. I don’t care if you use SLR or your iPhone – just start taking pictures.

The goal is for patients to understand their treatment options, to be engaged in the process, and accept recommended treatment.”

Finally, he urges new dentists to find clinical and business mentors who will share their time and energy to help you continue to move forward. “I think having a mentor is the key to survival in the profession. I had two mentors, and I was very lucky.”

Today Dr. Krieger is pursuing his lifetime dream of becoming an orthodontist. He is enrolled in an orthodontic residency program and will complete his studies in 2014. You can learn more about Dr. Krieger and the Krieger Continuum at www.kriegercontinuum.com.

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* All programs subject to credit approval and loan amounts are subject to creditworthiness. Some restrictions may apply. Bank of America Practice Solutions may prohibit use of an account to pay off or pay down another Bank of America account. ♥ Bank of America Practice Solutions makes no express or implied warranties with respect to any aspect of the Practice Heartbeat® program, nor does it guaranty any success or promise any results, and hereby disclaims the same to the extent allowed by law. The opinions of Bank of America Practice Solutions are based upon prior experience, and it makes no promise or guaranty that you will achieve any particular measure of success or results by participating in the program. You are not bound by any recommendations provided under this program and retain full responsibility for the results achieved by your professional practice.

Proudly endorsed by: † Bank of America Practice Solutions engages Scott McDonald & Associates, a national marketing firm specializing in demographic research, site analysis and profile reports for health care professionals to produce a demographic report to assist health care professionals in evaluating where to locate their professional practices. Scott McDonald & Associates charges a fee for this service, which is passed on to the customer.

Bank of America is a registered trademark of Bank of America Corporation. Bank of America Practice Solutions is a division of Bank of America Corporation, N.A. ©2013 Bank of America Corporation

A Compendium of Contemporary

Permanent Cements:

Clinical considerations for the new dentist in selecting the appropriate permanent cement for indirect restorations

By Ashanti D. Braxton, DDS; Mojdeh Dehghan, DDS; James F. Simon, DDS, ME.d

A

s a new dentist one is faced with overwhelming excitement, new challenges, and complex decision-making. This new journey is filled with great promise and success; yet there are times where one will experience uncertainty. Transitioning from a student-doctor to a dentist is a magnificent accomplishment. Still, the new dentist will need the help of his/her more experienced practitioners and will need to continue to stay current and informed of the latest trends in dentistry. Dentistry is forever making positive advancements, particularly with dental materials. Thus, the selection process in deciphering which dental material is best or most suitable has become more challenging than ever before.

The focus of this article is to provide the new dentist with a simplified, cohesive guide in understanding the properties and classifications of contemporary permanent cements used in most dental offices today for the cementation purposes of indirect restorations. Cementation is a key phase in the application of effectively ensuring the retention, marginal seal, compatibility, and durability of indirect restorations.1 Years ago, the decision of which permanent cement to use was simple with the availability of essentially only one luting agent, zinc phosphate cement.2 Today, a plethora of available Ashanti D. Braxton, DDS Assistant Professor University of Tennessee College of Dentistry Memphis, TN abraxton@uthsc.edu Mojdeh Dehghan, DDS Assistant Professor University of Tennessee College of Dentistry Memphis, TN mdehghan@uthsc.edu James F. Simon, DDS, ME.d Professor and Director of Esthetic Dentistry University of Tennessee College of Dentistry Memphis, TN jsimon2@uthsc.edu

16 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

permanent cements exist, thus making the proper selection more overwhelming for the new dentist. This article is intended to help alleviate the complexity of selecting the appropriate cement for clinical situations that new dentists endure in their private practices. The major classes of cements will be identified as well as what can be expected of these products in clinical performance.3 It is the responsibility of the dentist to adhere to the manufacturer’s instructions for the selected dental cement, which will enhance the success and longevity of an indirect restoration.

CONTEMPORARY PERMANENT CEMENTS The most-used dental cements are classified by their main components into two main groups: resin modified glass ionomers and resin cements.

Resin-Modified Glass Ionomer Cement (RMGIC):

Resin-modified glass ionomer cements evolved from advancements with the traditional glass ionomer cements involving supplementing part of the polyacrylic acid with hydrophilic methacrylate monomers.4 This conjoins the benefits of a conventional glass ionomer and resin technology.3 The RMGIC exhibits the same advantages seen with the conventional glass ionomer such as fluoride release and chemically bonding to tooth structure. Postoperative thermal sensitivity and the degree of solubility are reduced significantly in RMGIC making this cement a favorable one.

The RMGICs are reasonably easy to use and are primarily indicated for cementation of crowns, bridges, inlays, onlays, and orthodontic appliances.2 Use of RMGICs on preparations with poor retention and resistance are not recommended.4 The RMGICs are typically designated for use with the following dental materials: metallic and PFM restorations, zirconia and alumina-based ceramics, and lithium disillicate pressed and milled (CAD/CAM) inlays and onlays.5 All-ceramic crowns such as IPS Empress® (Ivoclar Vivadent, www.ivoclarvivadent.com) or VITA In-Ceram® (Vident™, www.vident.com) should not be

Indirect Restorations

TYPE OF CEMENT

Resin-Modified Glass Ionomer Cement

Dual-Cured Cement with Self-Etching Adhesive

Auto-Cured Resin with Light-Cured Resin Cement Self-Etch Adhesive with Total-Etch Adhesive

Porcelain Fused to Metal Crown

✔

✔

✔

High Noble Metal Crown

✔

✔

✔

Fixed Prosthesis

✔

✔

✔ ✔

Porcelain Veneer Porcelain Inlay and Onlay

✔

✔

All-Ceramic Crown

✔ ✔

✔ ✔

In-Ceram & Procera

✔

cemented with these cements because of potential clinical fractures.6 Of the various manufacturers of RMGICs, some commonly used brands include FujiCEM™ and Fuji PLUS (GC America), RelyX™ Plus Luting Cement (3M ESPE), and Riva Luting Plus (SDI Limited, www.sdi.com).7 Resin Cements:

Resin cements are the newest and latest in the attempt to develop a more universal cement that can be used for any type of permanent restoration. Resin cements can be used for all indirect restorations and are the only kind of cement recommended for all-ceramic restorations. Their composition is mainly composed of blends of polymerizable monomers of dimethacrylates. Dimethacrylates polymerize into densely cross-linked polymers, which are highly impervious to moisture and are highly durable.3 Resin cements are comparable to composite restorative materials, but incorporate a lower percentage of filler particles (50% to 70% by weight with glass or silica), enabling superior esthetics and color stability.8 Advantages exhibited by resin cements are low solubility, high bond to tooth structure and porcelain, and high strength. For the purpose of this article, resin cements will be catego-

✔

rized according to their polymerization mechanisms into light-cured, dualcured, and chemical-cured. In addition, resin cements will also be categorized by their adhesive system, which allows the cement to adhere to the tooth structure: total-etch, self-etching, and self-adhesive.9 The self-adhesive resin cements, which are the newest kind of resin cement, are interchangeably referred to as “all-in-one” resin cements or universal cements.10

POLYMERIZATION MECHANISM Light-Cured Resin Cements:

Light-cured resin cements contain photoinitiators, mainly camphorquinone, which is activated by light from the light-curing unit.11 Advantages include increased working time, decreased color instability and finishing time, and easier manipulation due to the lack of preparation process.11 Adequate light to initiate and maintain the polymerization process is extremely imperative with this type of cement, and should be used with caution in clinical situations where restorations are thick and cavities are deep. Lightcured resin cements are best suited for bonding esthetic restorations, such as ceramic veneers, inlays and onlays, and metal-free restorations.7 Examples

of the most commonly used lightcured resin cements are the following: Variolink® Veneer (Ivoclar Vivadent), RelyX™ Veneer Cement (3M ESPE), Calibra® (DENTSPLY Caulk), and CHOICE™ 2 Veneer Cement (BISCO Dental Products, www.bisco.com).12 Dual-Cured Resin Cements:

Dual-cured resin cements are unique in that they are capable of being cured by both chemical (self-cure initiators) and light (photoinitiators). Dual-cured resin cements are indicated when the ceramic is too thick or too opaque for complete light transmission through it. The added advantage of utilizing a curing light with these cements is enhanced effectiveness of the polymerization process. Dual-cured resin cements are best suited for bonding esthetic restorations, such as inlays and onlays and metal-free restorations. The bonding system used with these cements should be selected with care as not all systems work with these cements. Sometimes a dual-cure activator must be added to the bonding system to make them compatible. Examples of some of the most commonly used dual-cured resin cements are the following: NX3 Nexus® Third Generation (Kerr Dental Corporation, www.kerrdental. com), RelyX™ ARC Adhesive Resin Cement (3M ESPE), RelyX™ Unicem Self-Adhesive Universal Cement (3M ESPE), DUO-LINK™ (BISCO), Multilink® Automix (Ivoclar Vivadent), SpeedCEM® (Ivoclar Vivadent), and Maxcem Elite™ (Kerr).3 Self-Cured Resin Cements (Chemical-Cured):

Self-cure resin cements are capable of being completely cured with a chemical reaction, eliminating the need of a light for polymerization. These cements are best suited for cementing metal or WINTER 2013

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“It is important to remember not to mix and match bonding systems with different cements …”

Your career, our mission.

opaque ceramics such as NobelProcera™ Alumina (Nobel Biocare, www.nobelbiocare.com), and VITA In-Ceram® Alumina (Vident).7 Advantages include the ease of use and simplification, yet these cements are limited by their few varieties of available shades and translucency.

Examples of the most commonly used self-cured resin cements are the following: Panavia™ F2.0 (Kuraray Dental, www.kuraraydental.com) and C&B Metabond® (Parkell Inc., www.parkell.com).3

At Aspen Dental, you don’t have to go it alone. You can join a team that has your best interests at heart and your patients’ best care in mind. You can learn, grow and succeed alongside the best in the business. You can make a patient smile, and go home and see your family do the same. At the end of the day, it’s more than your career. It’s your life. Take the next step. Contact your local recruiter at 866.748.4299.

ADHESIVE SYSTEM Total-Etch Resin Cements:

This system incorporates using a 30% to 40% phosphoric acid-etch to etch tooth structure. These cements and the adhesives used with them can be light- or dual-cured and allow for maximum adhesion, but require the most steps to bond to ceramic restorations.13 Newly released systems (Caulk’s Prime&Bond Elect, 3M’s Scotchbond Multi-Purpose, and Bisco’s All-Bond Universal) are marketed as being successful with or without the prior use of phosphoric acid. Although patients may experience some postoperative sensitivity with this system, it is best suited for veneers and translucent inlays and onlays.7 Self-Etch Resin Cements:

This system involves the use of an acidic-based primer that allows a traditional composite-resin cement to adhere to tooth structure. The self-etching system avoids the use of separate etchants and adhesives and provides for an easier procedure with reduced potential for sensitivity. Studies show that the bond strength to enamel may be lower than that of the total-etch system, and it may be wise to etch the remaining enamel with phosphoric acid prior to use in order to overcome this issue.

Clinical success is achieved when used properly with tooth-colored inlays and onlays and moderate-strength all-ceramic crowns.14 Self-Adhesion Resin Cements:

Dr. Melissa Thompson

This new-generation system allows for self-adhesion or self-etching of the cement to tooth structure without the use of an etchant, adhesive, or self-etching primer. Selfadhesion resin cements exhibit a decrease in postopera-

AspenDentalJobs.com

CONTINUED ON PAGE 31 >>

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To Refer or Not to Refer … an Oral Surgery Case

I

t all depends, says Dr. Alan Shelhamer. This Carlsbad, CA, oral and maxillofacial surgeon, who completed a four-year residency program in oral and maxillofacial surgery at the Naval Medical Center in San Diego in 2004, emphasizes that it depends on the practitioner’s level of education, experience, and training.

“Those with a broader surgical experience, those that may have done an externship during dental school, those that have done an advanced education general dentistry residency or a hospital-based general practice residency tend to be more comfortable removing erupted teeth and taking out teeth that are partially erupted; even some are comfortable removing impacted teeth. If the cases are beyond the scope of what the doctors are comfortable with, they are going to want to consider referring them out. It’s important for dentists to remember that if they perform the procedure, they are held to the same standard of care as an oral surgeon.” And that could be reason enough for many general practitioners, especially new dentists, to put down the forceps.

Dr. Shelhamer acknowledges that dentists early in their careers tend to be particularly timid about performing oral surgery. Having served in the Navy, he was the department head for oral and maxillofacial surgery at the Naval Hospital Camp Pendleton, and the oral surgery mentor for

20 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

general practice residents from dental schools across the country. “The average graduate got out of school having taken out about 10-15 typically periodontally involved teeth. Many of them were very uncomfortable reflecting a full-thickness soft-tissue flap to expose tooth or bone, and many were uncomfortable using a surgical handpiece.”

While dental school curricula vary, the lack of experience among many practitioners understandably creates a heightened level of anxiety. However, it doesn’t mean that new dentists should refer every extraction. Rather, Dr. Shelhamer urges new dentists to make a determination on a case-by-case basis. The first point to consider is whether the patient is medically suitable for the procedure. It requires careful clinical assessment of the patient.

“You want to ensure that there are no medical conditions that would potentially create complications in the office or after the fact. There are many patients these days who have cardiac stents, and they are on various blood thinners, CONTINUED ON PAGE 22 >>

To Refer or Not to Refer continued from page 20

which can promote significant bleeding after the procedure.

There are pacemaker issues, and cardiac issues, and pulmonary issues.”

Next, new dentists should evaluate the procedure’s degree of difficulty. “Is this a tooth with bone loss that is already mobile, and the removal procedure is pretty predictable? Or is this a tooth that scratches the gum line on a patient with very dense bone, and the tooth has had a root canal treatment, so it will be more brittle? There are local factors to consider with each case.”

Moreover, most general dentists typically have a basic surgical tray with the bare minimum periosteal elevators, standard elevators, and a selection of one or two forceps.

“It’s important to consider what would be a good basic armamentarium to deal with these procedures. We use a

Alan Shelhamer, DDS, Diplomate, American Board of Oral & Maxillofacial Surgery

PHOTO COURTESY OF DR. ALAN SHELHAMER

“I definitely encourage dentists to practice the full scope of dentistry that is within their comfort level.” periotome, which is a very thin, delicate instrument that is designed to sever the periodontal ligament attachment to the ovular bone and remove the tooth without disrupting a lot of the local anatomy. The periotome has become a very popular instrument for performing the routine closed extractions,” explains Dr. Shelhamer.

Additionally, Dr. Shelhamer recommends that dentists always have a contingency plan, specifically an established relationship with an oral maxillofacial surgeon they can call at moment’s notice. “If you are in the middle of a procedure, and you fracture that crown off and you realize that you don’t have the instruments or the ability to predictably remove the tooth at that point, you can implement the contingency plan. This will allow the patient to have the procedure completed in a timely manner.”

Part of establishing a solid contingency plan is to establish strong relationships with oral surgeons in your community. “I’m always delighted when a new dentist contacts me to talk about the types of procedures we perform here in the office and being able to build a rapport with a new dentist,” says Dr. Shelhamer. He recommends that new dentists pay attention to reputations and look for a practice that is known for providing excellent care. Additionally, it’s important to understand the scope of services that oral surgeons in the community provide. Some may focus CONTINUED ON PAGE 27 >>

22 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

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Meet Dr. Jared Simpson, Advisory Board Member Keep an Open Mind

F

or New Dentist™ Board Member Dr. Jared Simpson, entering the profession brought a fair share of challenges, a few surprises, and no shortage of rewards.

This Bakersfield, CA, general practitioner credits his desire to enter the field of dentistry to his family dentist and his parents. “I had a great experience as a child with my family dentist. Both my parents were in health care on the medical side. I was introduced to it early on. You can make a good living and have a family.”

A graduate of the Dental School at the University of Texas Health Sciences Center, Dr. Simpson has been in practice for seven years. Two years ago he started a practice from scratch.

Today he operates with a lean staff that includes an office manager, dental assistant, and contractual hygiene services.

Upon entering the profession, Dr. Simpson acknowledges that the prevalence of dental disease was a shock as were the physical demands of dentistry. “I started practice in community health, and I didn’t expect to see such a huge volume of dental need. My parents weren’t wealthy, but they made sure I got to the dentist. I never had a cavity until I was 18. I had orthodontic treatment. The dentist was a pleasure for me as a kid. I didn’t realize the number of people who don’t have good dental care or don’t prioritize it. I see a massive amount of untreated dental disease. The other

Dr. Simpson’s Go-To Products Acteon SOPROLIFE. “I love my intraoral camera. I added the camera about a year into practice, and it was a mistake for me to not have it day one – to show patients here’s what I see. It really increased my case acceptance. It has a diagnostic mode that uses fluorescent light to show healthy and diseased teeth. It’s also helpful during treatment. I can turn the camera to that diagnostic mode. I can see if we are on the proper area to ensure that I am not over prepping a tooth.“ Ultradent V3 Ring Composite System.

“I love the V3 Composite System.”

Picasso AMD laser.

“I’ve found that to be very helpful in my restorative treatment.”

24 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

Dr. Jared and his wife, Kim, along with their children, Ethan, Landon, Ashton, and MacKenzie. PHOTO COURTESY OF DR. JARED SIMPSON

thing that surprised me is that dentistry is a lot tougher than you think it is. It’s much more physically demanding than people realize.”

While he emphasizes that he loves his work, like most practitioners, there are aspects of the dental profession that are challenging. “The level of understanding of oral health is very frustrating. If patients don’t feel pain, they think nothing is wrong. Sometimes people treat you like a salesman and that’s not my style. I had a young child in recently who I treatment-planned for sealants six months ago. The child was in yesterday for six-month recall. I can’t seal one of the molars because it now has a cavity. Now the family will have to spend more money and more time for restorative treatment, and the tooth will have long-term needs. The lack of understanding is frustrating.

“Insurance dependency is frustrating. As a new professional I have to deal with more insurance-dependent patients. It can be tough to negotiate what their benefits cover and to explain why it might be important to move forward. It is also frustrating to deal with phobias. That’s a challenge, but I don’t shy away from it. Being your own boss can be frustrating – overconfidence can interfere with good judgment. But I look forward to going to work. I don’t have any regrets.”

Dr. Simpson enjoys the rewards that come with helping his patients and working in a profession that requires both scientific and artistic skills and training. “I think it’s fun

to work with my hands and to help people. I like being able to diagnose the problem and see the results of treatment. Dentistry is a great place to do that. I like the materials and the technology that help us to get better and more efficient.”

He urges his fellow new dentists to take their time learning the profession and determining how they want to practice. “Don’t be in too big a hurry. Most of us are going to practice between 25 and 35 years. Don’t feel like you have to know everything right away. Be open-minded about practice opportunities. There are a lot of ways to practice. You don’t have to be a solo practitioner to be happy. Be dedicated to learning. I try to pick something to focus my education on every year or two, so I can improve my practice.

Be open to practicing everything in general dentistry or hone your skills to

specific areas. I would encourage new dentists to be financially conservative as well. People want to have the fancy house, car, etc. I‘ve seen a lot of young professionals really limit themselves because of debt. When you get out, don’t be in too big a hurry to have everything. That extra debt is hard to sleep with at night. It interferes in your ability to be ethical with patients.”

When it comes to growing his practice and communicating with patients, Dr. Simpson says he has very good luck with the Patient Activator tool available through 1-800-DENTIST. “We use Patient Activator as a marketing tool, and we pay for it on a monthly basis. It will send text, email, and phone messages to confirm appointments. We can also use it for newsletters, birthday wishes, and ad campaigns. We‘ve had very good luck with this, and it has been money well spent.”

Dr. Simpson also urges fellow new dentists to get involved in the profession through organized dentistry, study clubs, and continuing education. “I started a new dentist study club, which was a way for me to get to know my colleagues and find out what they are doing. We get together every couple of months. It’s great to get to know my peers. And it allows me to talk to people when I have concerns or need other opinions, and don’t have to travel very far to learn things.

He notes that he attends specific meetings offered by the American Dental Association and the California Dental Association. “I enjoy the ADA New Dentist Conference. I’ve gone to that meeting for three years, and I’ve found that to be very helpful. We all have the same issues; classes are designed to talk about things that new dentists would be interested in.”

WINTER 2013

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To Refer or Not to Refer continued from page 22

on implants, others on third molars, and still others on pathology or maxillofacial surgery, which is why it is essential to determine which surgeons are best for which procedures.

Additionally, Dr. Shelhamer emphasizes that it is important to find an oral surgeon that you can have a collegial relationship with. “Oral surgeons have a reputation for being arrogant and difficult to work with. It’s important that the surgeon and the staff in the oral surgery office have the type of personality that you are comfortable calling if you have an issue or concern with a patient. Having a good rapport with the surgeon goes a long way in ensuring that patients are taken care of very quickly.”

From there, communication with the patient will be critical in maintaining a good relationship with the oral surgeons to whom your practice refers. Dr. Shelhamer notes that dentists should take specific steps to prepare the patient for a positive oral surgery visit. The patient should fully understand what the diagnosis is on the tooth, what the oral surgeon will do, and what the likely treatment will be after the oral surgery. “The general practitioner is the quarterback of the team. They are the ones who make the assessment and explain to the patient why the tooth can’t be restored, why it needs to be removed, and what their options are. This goes a long way in setting patients up for a good outcome. Sometimes patients are sent in and they don’t understand why they are there, and the oral surgeon has to justify why a particular tooth needs to be removed.” And that is not a good situation for the dentist, surgeon, or patient.

As general dentists, recognize that you do have a basic core of training beyond just restoring teeth, notes Dr. Shelhamer. “I definitely encourage dentists to practice the full scope of dentistry that is within their comfort level.”

And develop a good relationship with an oral surgeon that you can call upon should that seemingly routine extraction or procedure suddenly become anything but routine.

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My HIPAA Notice is Revised,

Now What?

W

hat do the enactment of GINA, the American Recovery and Reinvestment Act of 2009, the HITECH Act, and the Breach Notification Rule have in common? These seemingly unrelated laws and regulations have led up to the need for health care providers to make revisions to their patient HIPAA Notice of Privacy Practices.

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits the use of genetic information in health insurance and employment and discrimination based upon genetic information. The American Recovery and Reinvestment Act of 2009 made amendments to the Health Information Technology for Economic and Clinical Health (HITECH) Act. It has a long history. It dates back to legislation that was passed four years ago. But finally the day has come and gone. This year on September 23, health care providers were required to make revisions to their HIPAA Notice of Privacy Practices. The revisions were first proposed by the Department of Health and Human Services (DHHS) in July 2010.

If you have not already seen a list of the revisions, below is a summary of the changes. The rule changes include: 1. Making business associates directly liable under HIPAA. 2. Strengthening the limitations on the use and disclosure of protected health information for marketing and fundraising purposes.

3. Prohibiting the sale of protected health information without authorization.

4. Expanding an individual’s right to receive electronic copies of their health information.

5. Restricting disclosures to health plans concerning treatment for which the individual has paid out of pocket in full.

6. Modifying authorization and other requirements to facilitate research and disclosure of child immunization proof to schools.

7. Enabling access to descendent information by family members and others.

8. Adopting changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure, and addressing willful negligence.

9. Modifying the HIPAA Privacy Rule as required by GINA.

28 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

By Mary Beth Gettins, J.D.

Following the long history, the DHHS issued the final HIPAA rule modifications in January of this year. They became effective in March. And you should have incorporated the applicable changes into your HIPAA Notice of Privacy Practices as of September 23. In the expressed words of the regulations, the revisions “are significant and are important to ensure that individuals are aware of the HITECH Act changes that affect privacy protections and individual rights regarding protected health information.” Hence the final rule issued in January dictates revisions to and distribution of a revised HIPAA Notice of Privacy Practices.

September 23, 2013, was the deadline to update your HIPAA Notice of Privacy Practices. With the deadline come and gone, you may ask, now what? Here is a list of three things you should do and one thing you don’t have to do!

•

Don’t Call the Printer. You are not required to print and distribute a revised HIPAA Notice of Privacy Practices to existing patients. However, you should have available upon request a copy of the revised HIPAA Notice of Privacy Practices and provide to all new patients a copy of the revised Notice of Privacy Practices.

There is no mandate to give your existing patients a copy of the revised HIPAA Notice of Privacy Practices.

•

Frame it. If patients come into your office for treatment and services, you must display a copy of the HIPAA Notice of Privacy Practices in your office. With the revised notice completed, get a frame, frame it and hang the Notice of Privacy Practices on the wall in your waiting room.

The rule does allow a summary of the HIPAA Notice of Privacy Practices to be displayed as long as the full notice is immediately available (such as on a table directly under the posted summary) for individuals to pick up “without any additional burden.” You cannot

Mary Beth Gettins is a tenured business attorney with a background in franchising and health care. Before entering the legal profession, she worked for more than nine years in the health care industry. Upon being admitted to the practice of law, she worked as general counsel for national brands. As managing attorney of Gettins’ Law, she continues to bring her knowledge and experience to national brands and small business owners. She can be contacted at mbgettins@gettinslaw.com or 513-400-3895.

require individuals to ask the receptionist for a copy of the full HIPAA Notice of Privacy Practices. This would be considered an additional burden. This is a new option available to providers mentioned in the preamble to the regulations. But use caution if you opt to display only a summary of the notice. There is little guidance on what constitutes a summary, what constitutes an additional burden, and this does not replace the duty to provide a complete copy of the Notice to new patients.

•

•

Post it. Perhaps you have a website promoting and announcing your services. The HIPAA Notice of Privacy Practices needs to be posted on your website.

A full copy of Notice of Privacy Practices should be posted on your website unabridged. The Notice of Privacy Practices may be a link or on a tabbed page.

And make sure to have the Notice of Privacy Practices easy for patients to find on your website.

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Be informed. The revised HIPAA Notice of Privacy Practices requirements include numerous new provisions. Make sure that you and your staff are aware of the changes.

Ongoing staff training and continuing education are an expressed requirement under federal regulations. In most, if not all, privacy enforcement actions, the lack of ongoing staff training and education is identified and addressed.

If you have not done so already, take action to get aligned with the revised HIPAA Notice of Privacy Practices requirements. With the escalated civil money penalty structures, do not delay.

WINTER 2013

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29

New Dentist™ Board Member Helps Establish Clinic Sometimes, all it takes is merely the courage to ask the question and perhaps a good sense of timing.

A

little over a year ago, New Dentist™ Board Member Dr. Charles Cheney found himself on the receiving end of one of those questions. He was in a conversation with Sue Brockman, who is now executive director of the Rapha Clinic in west Georgia.

At the time, Ms. Brockman was trying to establish the nonprofit community health and dental clinic. The plan was to provide a comprehensive range of services for individuals without insurance or other means to pay for the care.

But Ms. Brockman did not have a medical background.

She did, however, have a good idea of whom to ask to help her establish the clinic, and among her team of advisors was Dr. Cheney, a general practitioner in Newnan, GA. He was instrumental in helping to get the dental clinic established, and over the course of the past year, he has served as a regular volunteer at the clinic.

“The clinic focuses on emergency procedures and getting patients out of pain. We do a lot of extractions, as well as provide treatment for infections, oral exams, X-rays,

Invention

continued from page 6 it. We’ve started recommending it to our patients. A lot of our patients are elderly who have a tough time flossing and children whose parents have a tough time flossing for them. I think the device will be very popular with those two patient groups. Every day we tell our patients ‘you have to floss, you have to floss.’ There’s never been any other way except traditional flossing to do that. Now we have another option. The way I look at it, if 25% more of my patients floss, that’s a huge improvement,” says Dr. Zak. Dr. Pruett explains that the soft launch enabled him to learn a lot about what people liked and didn’t like about the product. “We took every bit of feedback and tried to apply it. We’ve tested it on our patients, fellow professionals, and colleagues. This really is a new way to floss. We really honed in on that we need to educate people how to use the product, 30 WWW.THENEWDENTIST.NET W I N T E R 2 0 1 3

and hygiene services,” noted Dr. Cheney. He likens his experiences in the clinic to his military deployment in terms of the numbers of extreme cases and dental emergencies. “It is quite a bit different from what I do in my day-to-day practice where I might take out three or four teeth on a patient.

In the clinic, full-mouth extractions are not uncommon. We are fortunate to have a set of Physics Forceps™ that we use to perform many of the extractions in the clinic.”

Dr. Cheney says the clinic plans to begin offering limited restorative procedures in the coming months. In addition to dental services, Rapha clinic, which relies exclusively on donations, also offers medical and vision care to the uninsured and underinsured.

Since opening, the Rapha Clinic has seen nearly 4,000 patients, though it is estimated there are about 19,000 individuals in Carroll County, GA, who have no insurance or are underinsured. “That is one reason the clinic is constantly seeking donations and volunteer support to allow more services to be offered on multiple days,” explained Dr. Cheney. Since the clinic first began offering dental services in November 2012, the clinic has been fortunate to have six dentists consistently volunteer. Unlike the medical services offered by Rapha, there are slight fees for most dental procedures. “But the cost is significantly discounted compared to what would be paid at a regular dental office,” noted Dr. Cheney.

To learn more about the Rapha Clinic, visit www.raphaclinicwestga.org.

because it’s a totally different approach to flossing.”

He notes that the response to the product was so positive that they decided to launch it publicly in September. “We had planned to spend a full year on the soft launch, gathering feedback and fine-tuning it. But we’ve had great success and made a huge dent with patient compliance, so we felt like we could bring it to the market ahead of schedule.”

The device features a sonic-powered handle to make flossing quick and easy. It is designed with a “bumper,” so it protects the gums from trauma. In addition to their flossing capabilities, both the Flossolution® 500 Series and Flossolution® Lite, which is a lighter, nonpowered version of the device, feature brush attachments to replace the floss attachments, making it easy to go from flossing to brushing. The “brusharms” are designed to prevent what Dr. Pruett calls the second-biggest problem in preventive dentistry today, toothbrush abrasion. For more information, visit www.flossolution.com.

Cements continued from page 18 tive sensitivity and clinical steps, as well as less susceptibility to moisture.15 These resin cements are designed for universal application in cementation of ceramic, composite, and metal-based restorations. Studies show successful outcomes with cementation of inlays, onlays, crowns, and posts (including fiber posts) made of metal and ceramic.

RelyX Unicem (3M/ESPE), BisCem (Bisco) and SpeedCem (Ivoclar) are examples of self-adhesive universal resin cement that is dual-curing and is utilized by many practicing dentists.

CONCLUSION Cementation is an essential and vital procedure in the management of teeth with indirect restorations, thus careful consideration must be implemented when selecting the appropriate cement to use. Dental cements continue to emerge on the market with constant modifications engineered by the manufacturers aimed to produce a superior â&#x20AC;&#x153;universal cement,â&#x20AC;? yet dentists are still faced with the complex decision of which cement to use. It is important to remember not to mix and match bonding systems with different cements without prior knowledge as sometimes they will not work together. The most important concept that dentists must realize is that it is the clinicianâ&#x20AC;&#x2122;s responsibility to be knowledgeable of

the characteristics and properties of the cement, indirect restoration, and the prepared tooth. With this knowledge, the new dentist can expect to achieve clinical success.

References: 1 Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: recommendations for success. J Am Dent Assoc. 2011;142 Suppl 2:20S-4S. 2 Cornelis H. Pameijer, â&#x20AC;&#x153;A Review of Luting Agents,â&#x20AC;? International Journal of Dentistry, vol. 2012, Article ID 752861, 7 pages, 2012. doi:10.1155/2012/752861 3 Simon JF, de Rijk WG. Dental cements. Inside Dentistry. 2006;2(2):42-47

Burgess J, Ghuman T. A practical guide to the use of luting cements-A Peer Reviewed Publication.

Available at: http://www.ineedce.com/courses/1526/ PDF/APracticalGuide.pdf. Accessed August 6, 2012.

4

CONTINUE YOUR

FREE SUBSCRIPTION TODAY!

5 Dental Cements: An Overview. Available at: www. dentistrytoday.com/dental-materials/6151-dentalcements-an-overview. Accessed August 6, 2012.

6 Dental Luting Cements. Available at: http://airforcemedicine.afms.mil/idc/groups/public/documents/ afms/ctb_108338.pdf. Accessed August 6, 2012.

7 Mojdeh D, Braxton A, Simon JF. An overview of permanent cements. Inside Dentistry.

2012;8(11):76-78 8 Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed prosthodontics. J Prosthet Dent. 1999:81(2):135-141.

9 Burgess JO, Ghuman T, Cakir D. Self-adhesive resin cements. J Esthet Restor Dent. 2010;22(6):412-419.

THE #1 JOURNAL FOR NEW DENTI STS

10 Simon JF, Darnell LA. Considerations for proper selection of dental cements. Compend Contin Educ Dent. 2012;33(1):28-36.

11 Pimmada Kesrak and Chalermpol Leevailoj, â&#x20AC;&#x153;Surface Hardness of Resin Cement Polymerized under Different Ceramic Materials,â&#x20AC;? International Journal of Dentistry, vol. 2012, Article ID 317509, 5 pages, 2012. doi:10.1155/2012/317509

Building a Great Team , ONE EMPLOYEE AT A

Radovic I, Monticelli F, Goracci C, et al. Selfadhesive resin cements: a literature review. J Adhes Dent. 2008;10(4):251-258.

12

Stamatacos C, Simon JF. Cementation of indirect restorations: An overview of resin cements.

Compendium. 2013;34(1):42-46

TIME

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Your CPA Considerations for Single Tooth Impla nts SPRING 2013

13

Polack M. Contemporary dental cements: An inside look at a vital dental material. Dental Products.

June 28, 2011.

14

15 Mazzitelli C, Monticelli F, Osorio R, Casucci A, Toledano M, Ferrari M. Effect of simulated pulpal pressure on self-adhesive cements bonding to dentin.

Dent Mater. 2008;24:1156-63.

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SKINNY

on the Street

The latest news on products and services for new dentists and their practices Eaglesoft 17

PHOTO COURTESY OF HERAEUS KULZER

Atraumatic Extraction and Socket Preservation on Live Patients Golden Dental Solutions, together with the University of Detroit Mercy School of Dentistry, is offering a one-day course primarily focusing on learning how to perform atraumatic extractions in all different types of situations. This course consists of a lecture in the morning, and then the rest of the day is spent on the clinic floor. Typically 50-75 patients are seen and more than 200 teeth are extracted.

This course offers seven CE credits and will be held on December 7. Drs. Richard Golden, Ara Nazarian, and Timothy Kosinski will teach the course. For more information, call 877-987-2284 or visit www.goldendentalsolutions.com.

The industry’s most intuitive practice management software is now even more user friendly.

Patterson Dental announces Eaglesoft 17, giving you the power to run a smart and efficient practice. New features to simplify your daily routine include customized medical history; Eaglesoft Newsfeed; Eaglesoft Web (coming in early 2014); Eaglesoft 3D Viewer by Dolphin, including improved imaging software that allows users to import and enhance images; Patterson Auto Update via the web, instead of using a disc to install updates; CareCredit Bridge, providing a direct link to process credit applications; and integrated Clinician Lite for Eaglesoft Clinician Users. For more information, visit www.Eaglesoft.net or call 800-294-8504.

PHOTO COURTESY OF EAGLESOFT

Heraeus Kulzer’s Venus Smile Store increases your profits and patient satisfaction. It gives you your own personalized web store to conveniently sell Venus White teeth whitening and oral care products to your patients online. Heraeus Kulzer develops and manages the website, while you retain a portion of all sales through your online store. Heraeus Kulzer also processes patient credit card payments and fulfills all online orders by shipping directly to the patient, so you don’t have to deal with inventory management and sales tax administration.

For more information, contact your Heraeus Kulzer representative, or visit www.heraeus-dental-us.com.

PHOTO COURTESY OF GOLDEN DENTAL

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a Practice a Practice

My business knowledge prior to starting my practice was minimal. You have to make a lot of decisions and I didn’t have any experience with hiring my first employee, what my financial arrangements were going to be or even how to create a business plan. I didn’t realize how much the banks valued this service to include it as part of my start-up loan! My personal McKenzie Coach was there to help me from before I found my location to supporting me the entire first year. I am very comfortable and confident now in my ability to own a dental practice. I’m MUCH farther ahead with McKenzie Management as my trusted advisor than I would have been thinking I could do it myself. I understand, now, the difference between “I think” and “I know”.

Partnering with McKenzie Management was the best!

They helped me get financing for my new practice which included their expertise for my first year. Honestly, I had no idea what I was doing. They helped through the acquisiton phase and then after I got the keys they were there to help get the existing staff on board. I knew that gaining the respect of the employees was not going to happen just because I signed their paycheck now. My McKenzie Coach went over all the business operations and developed a plan that enrolled them in the process, opened up the lines of communication and leveled the playing field for me as the “newbie” coming into their world. We had our new plan of action and the first year we increased the production by 23%! I haven’t worried one second about paying my loan! I have complete confidence in myself as a business owner thanks to McKenzie Management!

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