Virginia Dental Journal by Virginia Dental Association

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Volume 80

Number 3 - july/AugusUSeptemher - 2003

Virginia Dental Association Annual Meeting

Richmond Marriott Hotel and

Greater Richmond Convention Center

September 10- 14, 2003

THE VIRGINIA DENTAL ASSOCIATION

Virginia Dental Association

(VDA) / VIRGINIA DENTAL SERVICES CORPORATION (VDSC) have partnered with B&B INSURANCE, ASSOCIATES, INC. to service all your insurance needs.

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5204 Rolling Road, Suite B, Burke, VA 22015

Leslie S. Webb, Jr., D.D.S. Editor 1. Barry I Einhorn 2. Sharon Covaney 3. Michael R. Hanley

Susan P. Lionberger Director of Publications ASSOCIATE EDITORS 4 Kathryn Finley-Parker 5. Lori Snidow 6. Robert G. Schuster

Terry D. Dickinson, D.D.S. Business Manaaer 7. Mac Garrison 8. Scott McQuiston School of Dentistry James Revere

Editorial

Message From The President

Letter ToThe Editor

Custom Provisional Restorative Materials

Abstracts

2003 VDA Meeting Information and Registration

2003 Virginia Meeting Continuing Education

Donated Dental Services

Significant New Developments On The Tax Front

Direct Reimbursement

Help Make Your Office An Even Safer Place With An Automatic External Defibrillator

A Step By Step Management Method For Storage And Disposal of Amalgam Waste

VDSC Proudly Presents Our Newest Endorsed Vendors

VDANews

VDA Office's War Effort

New VDA Members

VADPAC Supports Primary Election Winners

Continuirq Education, Meetings and Events

Component and Speciality News

Classified Advertisements

COVER Virginia Dental Association 2003 Meeting Logo © 2003. Photo of Richmond courtesy of Richmond Metropolitan Convention and Visitors Bureau All Rights Reserved PUBLICATION TEMPLATE CIChange THE VIRGINIA DENTAL JOURNAL (Periodical Permit #660-300, ISSN 00496472) is published quarterly (January-March, April-June. July

September, October-December) by the Virginia Dental Association. 7525 Staples Mill Road, Richmond Virginia 23228, Telephone (804) 261-1610

SUBSCRIPTION RATES Annual Members. 56.00 Others $12.00 In US, 52400 Outside U.S Smgle copy 56.00.

Second class postage paid at Richmond. Virginia Copyright Virginia Dental Association 1996

POSTMASTER Send address changes to Virginia Dental Journal. 7525 Staples Mill Road, Richmond, VA 23228.

MANUSCRIPT AND COMMUNICATION for publications Editor 7525 Staples Mill Road. Richmond. VA 7:177R

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JOURNA,L

EDiTOR[AL

BOARD

Ralph L. Anderson James R. Batten Carl M. Block Cramer L. Boswell James H. Butler Gilbert L. Button B. Ellen Byrne Charles L. Cuttino III Frank H. Farrington Barry I. Griffin Jeffrey L. Hudgins Wallace L. Huff Lindsay M. Hunt, Jr. Thomas E. Koertge James R. Lance Daniel M. Laskin Karen S. McAndrew Travis T. Patterson III W. Baxter Perkinson, Jr. Lisa Samaha David Sarrett Harvey A. Schenkein James R. Schroeder Harlan A. Schufeldt John A. Svirsky Ronald L. Tankersley Douglas C. Wendt RogerE. Wood

Annual Meeting Andrew J. Zimmer

Infection Control & Environmental Safety Richard F. Roadcap

Budget & Financial Investments David R. Ferry

Institutional Affairs Elizabeth A. Bernhard

Caring Dentists Harry D. Simpson, Jr.

Legislative Dana H. Chamberlain

Communication & Information Technology Robert B. Hall, Jr.

Membership David B. Graham

Constitution & Bylaws Thomas S. Cooke III

New Dentist TimothyJ. Golian

Dental Benefits Programs Susan F. O'Connor

Nominating Thomas S. Cooke III

Dental Health & Public Information Samuel W. Galstan

Peer Review & PatientRelations Alan Robbins

Dental Practice Regulation

J. TedSherwin

Planning David C. Anderson

Direct Reimbursement Theodore P. Cocoran

Search Committee for VA Board of Dentistry Thomas S. Cooke III

Ethics & Judicial Affairs Charles E. Gaskins III

VADPAC Gus C. Vlahos

Fellows Selection Donald L. Martin

FOUNDATIONS Relief Foundation Scott H. Francis

Virginia Dental Health Foundation Ralph L. Howell, Jr.

2003 ADA DELSCATION Delegates:

144thADASession, October23-26,2003, San Francisco, CA

Anne C. Adams (2005) M. Joan Gillespie (2003) Ronald L. Tankersley (2005)

David C. Anderson (2004) Wallace L. Huff (2004) Leslie S. Webb, Jr. (2003)

Charles L. Cuttino III (2004) Bruce R. Hutchison (2005) Andrew]. Zimmer (2005)

Alternate Delegates: Richard D. Barnes (2004) Ronald J. Hunt (2003) William ]. Viglione (2003)

Thomas S. Cooke III (2003) Rodney J. Klima (2004) Gus C. Vlahos (2004)

Bruce R. DeGinder (2004) Kirk Norbo (2003) Edward K. Weisberg (2004)

Representing and serving member dentists by fostering quality oral health care and education.

OFACERS

President: Rodney J. Klima, Burke President Elect: Bruce R DeGlnder, Williamsburg Immediate Past President: Thomas S Cooke III, Sandston Secretary- Treasurer: Edward J Weisburg, Norfolk Executive Director: Terry Dickinson, DDS. 7525 Staples Mill Road, Richmond, VA 23228 EXECUTIVE COUNCIL

Includes officers and councilors listed and :

William J. Viglione, Charlottesville - Chairman

Mark A Crabtree, Martinsville - Vice Chairman Benita A Miller, Richmond M. Joan Gillespie, Alexandria Ralph L. Howell Jr., Suffolk Ex Officio Members: Parliamentarian: James R Lance, Richmond Editor: Leslie S Webb, Jr, Richmond Speaker of the House: Bruce R. Hutchison, Centreville Dean, School of Dentistry: Ronald J. Hunt, Richmond

COUNCILORS I James E. Krochmal, Norfolk

II McKinley L. Price, Newport News

III H Reed Boyd III, Petersburg

IV Anne C. Adams, Richmond

V Mark A Crabtree, Martinsville

VI Ronnie L. Brown, Abingdon VII Darwin J. King, Staunton VIII AI Rizkalla, Falls Church

VDASTAFF

Dr. Terry Dickinson - Executive Director

Stephanie Arnold - Director of Outreach Programs

Bonnie Anderson - Administrative Assistant

Linda Gilliam - Director of Finance Susan Lionberger - Director of Events & Publications Samantha Paulson - Director of Marketing and Programs Leslie Pinkston - Dir. of Membership Recruitment & Retention Nicole Pugar - Director of Public Policy Barbara Rollins - Asst. Director of Outreach Programs

SOCIETY

PRESIDENT

SECRETARY

PATIENT RELATIONS

Tidewater, I

Harvey H. Shiflett III 3145 VA Beach Blvd #104 Virginia Beach, VA 23452

Robert A Candler 116 Janaf Office Bldg Norfolk, VA 23502

Carl Roy 2100 Lynnhaven Pwky #200 Virginia Beach, VA 23456

Peninsula, II

EricW Boxx 113 Hampton Hwy Yorktown, VA23693

Sharon K Covaney 1313 Jamestown Rd 205 Williamsburg, VA 23185

Kent Herring 122700 McManus Blvd#102B Newport News, VA 23602

Southside, III

Samuel W. Galstan 12290 Iron Bridge Road Chester. VA23831

D. Kent Yandle 5716 Courthouse Road Prince George, VA23875

C. Sharone Ward 12290 Ironbridge Road Chester, VA 23831

Richmond, IV

AI J Stenger 7033 Jahnke Road Richmond, VA 23225

Kathryn Finley-Parker PO Box 15188 Richmond, VA 23227

Jerry L Jenkins 400 Old Hundred Road Midlothian, VA23114

Piedmont, V

Craig B. Dietrich PO Box4402 Martinsville VA24115

Randy J Norbo 1414 Franklin Rd, SW #3 Roanoke, VA24016

Craig B Dietrich 604 E Church Street Martinsville, VA 24112

Southwest. VI

Susan F O'Connor PO Box 1086 Galax, VA24333

Joseph P Schneider Route 1 Box 560 Cana. VA 24317

Paul T Umstott 300 W Valley Street Abingdon, VA 24210

Shenandoah Valley VII

C Mac Garrison 129 University Blvc SUite D Harrisonburg, VA 22801

Robert B Hall. Jr (Treasurer) 130 W Piccadilly St Winchester. VA 24401

Alan Robbins P.O. Box 602 Timberville, VA 22853

Northern Virginia VIII

Neil J. Small 9940 Main Street Fairfax VA22031

A Garrett Gouldin 101 West Broad St #601 Falls Church VA22046

Neil J. Small 9940 Main Street J='",irf~v

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Leslie S. Webb, Jr. DDS

VA Dental Journal Editor

Do you know about Direct Reimburse ment (DR) and understand how itworks? Would you like to have patients with DR plans in your practice? How would your receptionist respond if a patient called and asked if you participated in a DR plan? What education have you pro vided your staff about DR? Do you keep promotional materials and handouts about DR in your office? Do you edu cate your patients who are owners, CEOs, CFOs, or human resource man agers of companies about DR and en courage them to switch their dental in surance coverage to a DR plan? Do you know where to refer a business in terested in investigating or implement ing a DR plan for assistance? If you cannot answer these questions in the affirmative, you need to educate yourself about DR. DR provides a pa tient freedom to choose any dentist and plan their treatment with that dentist without preauthorization or third party interference. The dentist receives his normal fee for service. Many DR plans require the patient to pay the dentist and have him provide a receipt or sign a

form indicating services were rendered and paid for by the patient. Some DR plans called DirectAssignment require a form to be filled out so the employer can reimburse the dentist directly or through a third party administrator. DR plans offer flexibility of design for the employer, a choice of self-administra tion or third party administration, and are employee friendly. They can pro vide considerable cost savings to the employer because of reduced adminis trative costs. DR is promoted by both the American Dental Association and the Virginia Dental Association. You can find out more about DR at the ADA website www.ADA.org/DR, the VDA website www.vadental.org, by contacting the ADA Council on Dental Benefit Pro grams at 1-800-621-8099 or by calling Ms. Samantha Paulson, VDA Director of Marketing and Programs at 1-800 552-3886 or 1-804-261-1610. The VDA can provide DR marketing materials for your office or assist businesses want ing to evaluate a DR plan.

Not enough attention is being paid to the well being of dentists. The numer ous problems and difficulties, both per sonal or professional that we deal with, reduce our ability and desire to function at an optimum level in dental practice. If we could enhance well being by elimi nating or reducing problems that we bring on ourselves or that come to us courtesy of outside forces, consider what might result With enhanced well being, dentists would enjoy their work more, practice longer, and not retire as early We would produce quality clinical dentistry, serve our patients better, thus improv ing the overall health of those we treat, as well as, generate a more comfort able life for ourselves Improvement in the quality of life would positively affect those who depend on us, especially our staffs and our families, allowing us to devote more of our time to helping the less fortunate patients and those underserved segments ofthe population. Things that come to mind that are pre ventative for many situations that we bring on to ourselves are obvious and include having a personal life of reason able moderation and keeping our priori ties straight as relates to family and friends, with time for reflection and con templation. Taking time to reflect on our core values and purpose in life helps to refocus our perspective. For those of us whose lives have gotten out of fo cus with substance abuse, the VDA caring dentist committee has been there to help. Maintaining our professional ethics, which can best be described as doing the right thing at the right time for our patients, is essential for our well being and self respect We do not want our financial needs to determine our treat ment plans. Our financial management, including living within our means, and controlling debt affects ourwell being All of us know the pressure of debt obliga tions can be a crushing load and pro duce stress Howwe structure our prac tice business model, starting small and later adding to our office facilities as a practice grows, not bUilding more clinic than we need, equitable buy-sell con-

We need to be careful what we sign! If an agreement sounds too good to be true, it is! I am troubled by the stories I have heard recently of the fates that have befallen some of our members as a result of contracts they have signed with DMSO's. (Note: the tripartite has a contract review service.) One dentist who was ill and unable to work got fired from his own practice before he could get well and return to work. And one dentist from my area, who came back from being out awhile due to illness, was told he could not take his usual day off, then he was told his practice had to be combined with someone else's, and later on he too was fired! Another dentist got fed up with the OMSO he was contracted with and moved to terminate the agree ment, but instead got beaten to the punch and found himself terminatedfrom his own practice! Ouch! And now we read about UCCI auditing practices and forcing dentists to pay back fees they have already been paid for patient care. The provision allowing these audits was in the contract!

Our practices spend a great amount of time dealing with third party payers. We have seen tactics that discredit, de mean, delay, or deny reimbursement for bonafide dental services that have been performed. We hear of practitioners leaving the medical profession because of the frustration of dealing with insur ance companies and the inability of the doctors to practice the way they believe is best for their patients. Certainly, this is a huge factor in dentistry as well, and our tripartite is acting to try to remedy injustices by suits against Aetna Inc. and Wellpoint. We have read of recent ADA action against major Insurers pur suing alleged transgressions against "in network" dentists and seeking redress under the Racketeer Influence and Cor rupt Organizations Act (RICO)I It's time to take the offensive.

Rodney J. Klima, DDS VDA President

states have legal provisions prohibiting or restricting non-dentists from owning dental practices or from interfering with the clinical judgement of a dentist. States attempt to restrict non-dentist interference or ownership by making the act of owning a dental practice a defin ing element of practicing dentistry. However, forces like the DMSO's are working to change practice ownership laws. Nine states permit non-dentist participation in practice ownership. There is little case law to provide guid ance on statutory or regulatory restric tions on ownership, resulting in a lack of enforcement in some states. To help enforce ownership restrictions, many states also have restrictions on the use of trade names such as "Painless Den tistry," for a dental practice, and require that the name of the dentist appear in the name of the practice. The effect of the trade name statutes is to prevent public deception as to the identity of the responsible owner. One effect of non dentist ownership we hear is production quotas being set which suggests a pos sible scenario that treatment might be recommended whether the patient needs it or not. Before signing on to situations where we give up our control of our patients, we need to think back to the aspects of dental practice which attracted us in the first place, and con sider what might result if we give it up.

When I talk to students about why they are going into dentistry, one of the rea sons that consistently comes up is There is no lack of forces workina to t~cts,andn~bOITOWlngmo~th~a~n~w~e~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

we are the unwitting enablers. Fortu nately, we have our tripartite to look af

ter the best interests of all dentists. Besides the contract review service available through the ADA, our state and local patient relations, and peer review committees help mediate complaints from patients against members. Our tripartite lobbying, Grassroots Network, and Political Action Committees insure that the views of dentistry are heard by policy makers in the legislative and regu latory arena. Among the many recent benefits we have seen, these efforts help us to be able to come into compliance with the new HIPAA regulations and al low us to continue using cost versus accrual accounting which keeps us from having to pay taxes on what we bill ver sus what we actually collect. So many aspects of membership in the tripartite help our well being, even just getting together with our peers at meetings and discussing mutual problems can be like a group therapy session. Our own well being, if properly developed and cared for, is a watershed of good for our fam ily, our offices, and our community. This is the enduring legacy of our profession.

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Dr. Les:

Dr. Dr. Wilson

The time is long past when you should receive high compliments for your ef forts as the editor of our state journal. In my view, it is one of the finest of our profession's state journals, offering the reader an excellent balance of informa tion about clinical care, about national and international issues and about our colleagues' activities across our state.

Thank you for your letter regarding my work on the VA Dental Journal. I would like to recognize Susan Lionberger, Di rector of Events and Publications, for the tremendous job she does assem bling and pubiishinq the Joumal. I would also like to thank Dr. Terry Dickinson, VDA Executive Directory, and the en tire VDA staff for their contributions to the VA Dental Journal. It is truly a col laborative effort and I am most appre ciative of the support I receive.

The hours expended by our editor man date great sacrifice of personal and pro fessional time and you deserve the grati tude of all members of the Virginia Den tal Association.

Sincerely, Leslie S. Webb, Jr. DDS VA Dental Journal Editor

High marks to you, sir. Cordially,

Dr. Richard D. Wilson

ree spect (ri-spekt') n. 1. A high regard for and appreciation of worth. 2. Due regard or consideration. 3. The way Cincinnati

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This article provides the practitioner with a general overview of provi sional restorative materials and an update on new materials. The newer materials available today of fer excellent esthetic results, mini mal fabrication time, and improved marginal adaptation. Introduction One of the most important aspects of dentistry is to provide a predictable out come to any oral rehabilitation, and the use of the provisional restoration is a critical phase in the treatment of the dental prosthetic patient. An interim prosthesis generates specific informa tion about the functional and aesthetic requirements of the definitive restora tion. ~ The design for a provisional resto ration begins with a thorough and com plete gathering of diagnostic information and includes a determination of the fi nal result desired by the patient and practitioner. Provisional restorations must perform several important functions. The gen eral requirements of properly fabricated provisional restorations are as follows: Patient comfort/function Periodontal health Aesthetics and phonetics Strength and retention Occlusal function Pulpal protection Position stability Margin protection Each component of fixed prosthetic dentistry involves possible insult to the pulpal tissue. Prepared teeth must be restored temporarily while the final pros thesis is being fabricated to provide pro tection, positional stability, masticatory function, esthetics, patient comfort, and to obtain diagnostic information, such as the patient's ability to tolerate an in crease in vertical cimension.' In addi tion, proper occlusion can help to re duce future adjustments during delivery nf+h ................;..... :...;.. -. ----. ---

Marginal perfection is critical for suc cessful restorations and soft tissue health. During the interim between the preparation stage and the placement of the final prosthesis, provistonat restora tions must promote soft tissue healing. Gingival overgrowth and inflammationare minimized by well-contoured provisional restorations with good marginal integ rity.'

Selection Provisional materials should be selected based on their intended clinical appli cations. With the restoration of implants and with complex periodontally involved cases, provisional restorations are worn for extended periods of time. Under these circumstances, fracture resis tance and ease of placement become critical properties. When anterior units are involved, color stability and stain resistance are important. In all cases, operator convenience and ease of ma nipulation remain important consider ations. Types of Custom Provisionals There are four major types of custom provisional restorative materials: ethyl methacrylates, bis-acryl composite res ins, methyl methacrylates, and urethane dimethacrylate (UDMA) composite res ins (see Table 1). In general, ethyl and methyl methacrylates are powder-liquid systems, while UDMA resins are single component light-cured materials. Bis acryl resins, the newest materials, are two-component autocure or dual cure materials that utilize automix delivery systems. Provisional restorations made from ethyl and methyl methacrylates or bis-acryl resins can be fabricated di rectly on prepared teeth by placing the material directly into intracoronal prepa rations, or by using a matrix or template for single and multiple extracoronal provisionals. Alternatively, provisional restorations can be fabricated indirectly on casts or by a combination of direct and indirect technique, which will be discusser! !::ltpr Thp linht_("lIrQrlllr.~~"

composite resins are placed directly into small preparations, such as inlays. Ethyl, vinyl and butyl-methacrylates. Their advantages include low cost, mod erate strength, moderate color stability over a few weeks, moderate exother mic setting reaction and a relatively good fiP Ethyl methacrylates demon strate poor wear resistance when com pared to other materials and should be used with caution for a long span proth esis." Additionally, they exhibit an un pleasant odor and are radiolucent. Splintline ™ (Lang, Wheeling, IL) is an example of this type of material. Vinyl ethyl methacrylates, such as sn~ (Parkell, Farmingdale, Ny), Trim II (Bosworth, Skokie, IL), or Vita KHB TM(Vident, Brea, CA), are modifi cations with very similar clinical prop erties. Temp Plus™ (Ellman, Hewlett, NY) is a butyl methacrylate that be haves very similarly to the ethyl meth acrylates." Methyl-methacrylates. These are simi lar in chemical composition to pros thetic denture resin and commercially available plexiglass. Methyl methacry lates are also structurally similar to ethyl methacylates, however,there are impor tant differences between the clinical properties of the two. Methyl methacry lates demonstrate good wear resis tance, good color stability, high polishability, good esthetics, and low cost. 5 However, their disadvantages in clude high curing heat, high polymer ization shrinkage (8%), adherence to tooth structure in the absence of a sepa rator, and short working time. In addi tion, like ethyl methacrylates, they ex hibit an unpleasant odor, and are radi olucent." With these materials, an indi rect technique is usually preferred be cause the marginal fit can be improved by as much as 70% over a direct tech nique." Examples of methyl methacry late orovisional materials include 1M TW Alike (G-C, Alsip, IL~puralay (Re !ian~e, Worth, I~j Jet (Lang, Wheel

™ (SDS/Kerr, Orange, CA), and CA) , TabTM True Kit (Bosworth, Skokie, IL). Both ethyl and methyl methacrylates can be used with an indirect technique. Usually, ethyl methacrylates demon strate less polymerization shrinkage and thus better marginal integrity. Me thyl methacrylates exhibit greater hard ness and durability. Both materials in crease their density when cured in a pressurized container."

Sis-Acryl Composite Resins. Bis-aeryl resins are similarto BIS-GMA resins and possess several advantages, including low curing temperature, minimal poly merization shrinkage, high tensile strength and surface hardness, im proved marginal fit, good color stability, minimal odor, and high polishability. Most products are available in automix systems, which improve their ease of use. However, automix systems limit the practitioner's ability to alter the viscos ity of the material. The primary disad vantage associated with these systems is their high cost. These materials can be repaired or modified simply by add ing new material to the existing provi sional restoration. However, the need to add bonding agent prior to adding the new material might be considered a dis advantage. Bis-acryl resins can be used for most types of provisional restora tions. They make exceptional single partial veneer provisionals and are fair materials for directly fabricated long span provisional fixed partial dentu res. 5 Christensen states that these resins are among the safest to use because of their lack of exotherm. 3 Bis-acryl composites are available as TM autocure systems Protemp II (3M/ TM ESPE, St Paul, MN); Luxatemp (Ze . TM nithlDMG, Englewood, NJ); Integnty (Dents~'J'/Caulk, Milford, DE); Protemp Garant T (3M/ESPE, St. Paul, N1N) and dual cure systems Provipont DC™ (IvociarNivadent, Amherst, NY); Iso TempTM (3M/ESPE. St. Paul, Mn). Dual cure systems exhibit a chemical cure preceding the final light-cured set. In TM addition,lntertemp (E&D Dental Prod ucts , Somerset, NJ) TM is light-cured only and Triad VLC (Dentsply/Caulk, Milford, DE) is light-cured followed by postcuring in a light chamber. Triad dern

8 minutes.' The greatest temperature rise occurs when a thermal vacuum tem plate is used, followed by siloxane im pressions, irreversible hydrocolloid, and UDMA Composite Resins. These Iight finally, relined resin shells. The fabrica cured microfill materials provide interim tion of large span provisionals results in coverage for restorative preparations lo a greater intrapulpal temperature than cated in nonstress-bearing areas and a single unit prosthesis." Over-reduction restorations which receive minimallat or the presence of metallic restorations eral forces. This material may be best is likely to magnify thermal insults to used for conservative endodontic access the teeth. Precautions that may be openings and small inlay preparations taken to minimize iatrogenic insult to a with tooth-to-tooth enamel contact in tooth include, selection of materials, occlusal and proximal areas. These matrix selection, use of air water spray, polyester UDMA materials include and early removal. Fermit™ (IvoclarNivadent, Amherst,

NY) and Barracaid™ (CaulkiDentsply, Reinforced Provisionals Milford, DE). Advantages of these ma

The newer materials provide increased terials are low curing temperature, low

fracture resistance. However, long span shrinkage, no mixing, low odor, ease of

restorations and restorations with an use, ease of repair, and no requirement

intended long duration may require ad for cement. However, these materials are

ditional methods to improve their dura expensive, radiolucent, and non

bility. High-strength provisional restora polishable. Furthermore, they demon

tions are also indicated with patient's strate low strength and wear resistance,

who are unable to avoid excessive forces and do not prevent teeth from driftinq."

on the prosthesis, patients who have above-average masticatory muscle Esthetic Considerations

strength, and those with a history of fre Because of their color stability, quent breakaqe.s tt tne patient presents polishability, and handling characteris with a properly contoured existing pros tics, bis-acryl composite resins and in thesis, relining the rigid metal framework direct methyl methacrylates can provide may provide an acceptable provisional the most esthetic results. Regardless restoration. Other means of strengthen of the material used, highly polished ing include heat processing and rein surfaces provide the most esthetic and forcing materials. stain resistant restorations. Character

ization can be accomplished with color Reinforced Heat-Processed Acrylic modifiers or staining systems, such as Resin Provisionals. Heat-processed orblt' (G-C, Alsip, IL). Another alter acrylic resin is inherently stronger, more native includes the combination of den stable, and more resistant to polymer ture teeth as the facial component of breakdown than is autopolymerized anterior restorations and resin. Heat processing is indicated for autopolymerizing bis-acryl resin to con

provisional restorations involving multiple trol the shade and contour.'

preparations. Heat-processed provi sional restorations can be fabricated Intrapulpal Temperature During Di from prepared diagnostic casts and re rect Fabrication of Provisional Res lined clinically. Their advantages include torations

improved color stability, maintenance of Intrapulpal temperature rise is depen surface finish, and increased wear re dent on the type and volume of mate sistance. Moreover, with heat-processed rial, as well as the type of delivery ma

materials, incisal translucency and im trix, used. In general, the temperature proved esthetics can be achieved. These rise is the greatest with methyl meth restorations can be reinforced with base acrylate, followed by ethyl methacrylate. metal for added strength in the inter The composite resins exhibit the least proximal areas, permitting open embra temperature increase. Triad exhibits a sures to facilitate the patient's oral hy dramatic increase during the first 30 giene. In addition, occlusal contacts and seconds, unlike other materials, which vertical dimension are well maintained. 10 reach peak temperatures between 6 and

a greater marginal opening as compared

to other bis-acryl composite resins and

acrylic resins.

Composite Reinforcement Fibers. Composite resin fiber reinforcement pro vides greater strength and fatigue resis tance than does metal wire reinforce ment." Available products include CONNECT™ (SDS/Kerr, Orange, CA), TM GlasSpan (Glass Span Inc., Exton. PA), Lee Cosmetic Splinting Kit™ (Lee Pharmceuticals, South Elmonte, CA), RIBBOND™ (Ribbond Inc., Seattle, WA) and Splint-It ™ (Jeneric/Pentron, Wallingford, CT). Reinforced bis-acryl composite resin and polymethyl meth acrylate resin restorations demonstrate significantly higher fracture strengththan unreinforced restorations, 1213 with rein forced bis-acryl composites demon strating greater fracture resistance than reinforced methyl methacrylates." Es thetics is not compromised because the fiber becomes invisible when incorpo rated into the acrylic or resin. These restorations can be repaired easily with the addition of acrylic or resin .15 Fabrication Techniques Two basic methods are used to fabri cate custom provisional restorations the direct technique in which the mate rial is cured in the oral cavity, and the indirect technique where the material is cured outside the oral cavity. The direct technique is relatively simple and effi cacious. Heatgeneration and free mono mer contact with the tooth may have long-term pulpal trnpllcations." Ethyl methacrylate acrylics are best used in the direct technique." However, many clinicians prefer the indirect overthe di rect method for fabricating provisional restorations. 17 The indirect technique involves the use of patient casts and diagnostic wax-ups to evaluate, and if necessary, alter the existing occlusal pattern to maximize patient function and esthetics. srnau" lists the following advantages of the indirect technique: produces more accurate restoration margins, greater control of occlusal morphology, avoidance of potential harmful effects of direct contact with the methyl methacrylate, elimination of the objectionable odor, time-saving, and minimizes the need for relines. A com bination direct/indirect technique can effectively be used by the clinician. This technique involved a laboratory made temporary shell which has been made from the patients diagnostic casts. One or more orovision;:\1 rpc.tnr",tinnc "'>,, h"

made using this technique. A clinical reline of the shell is performed on the prepared tooth at the time of fabrication.5 Additionally, a triple-tray technique" can be employed. In this method a triple impression tray filled with addition sili cone material is used to fashion a ma trix, which is then filled with provisional restorative material and seated overthe prepared tooth to fabricate the provi sional restoration. Finally, McMaster' 9 describes the laminar impression tech nique for making provisionalrestorations. This technique uses a pretreatment impression of the prepared site, with entrance and exit holes strategically designed to access the tooth prepara tions. A bis-acrylic resin is injected into the entrance portal with a mixing tip. The provisional material egresses out the exit hole after it has adapted to the preparation. The material is allowed to set according to the manufacturer's rec ommendations. The impression tray containing the provisional restoration is then removed and the site and the res toration trimmed and adjusted. The au thor claims this technique to be virtu ally free of excess material on the adja cent teeth or soft tissue, as well as, extremely accurate and requires mini mal occlusal adjustments. Matrices which provide the form for tab ricating the provisional restoration may be made from a variety of materials which include: pink wax, alginate, trans lucent bite registration trays for light curing (Mernosu' , Bayer Inc. Dental Products, South Bend, IN), addition sili con Rutty, plastic or acetate (Temp Plus M , Ellman International, Hewlett, NY).20 Selection of any or all these ma terials is usually determined by the clini cal needs and personal preference of the provider.

eluding microfilllight-cured UDMA com posite resins) by employing the de scribed fabrication techniques.

Clinical Implications The placementof provisionalrestorations enables the patient and the clinician to preview the final desired outcome with confidence. The use of properly fabri cated provisional restorations permits a higher rate of success of the definitive treatment. Ethyl methacrylates, methyl methacrylates, bis-acryl composite res ins, and microfilled light-cured UDMA composite resins are each suitable in specific clinical situations. Figures 1 and 2 graphically demonstrates the es thetic result that can be routinely at tained using a bis-acryl composite pro visional restorative material. The clinician must evaluate which type of interim fixed restoration is desirable or required in each case. The repeated fracturing and repairing or remaking of provisional restorations can be frustrat ing and time consuming for to the pa tient and practitioner. The added strength of reinforced restorations can reduce clinical failures of multiple units or long span provisional fixed partial dentures. Laboratory costs and the time required to prepare secondary diagnos tic casts may be prohibitive for a three unit prosthesis, but for extensive restor ative cases, reinforced provisional res torations will often save clinical time.

In summary, this article provides the practitioner with a general overview of provisional restorative materials and an update on new materials. The newer materials available today offer excellent esthetic results, minimal fabrication time, and improved marginal adapta tion. Ultimately, it is the responsibility of the dental providerto effectively match Prefabricated vs Custom Restora provisional restorative material with the tions clinical demands ofthe patient and prac Prefabricated crown forms may include titioner. but are not limited to: Stock aluminum cylinders, anatomic crowns forms, clear References cellulose shells, copper band reinforced 1. Vahidi F. The provisional restoration NY acrylic, tooth-colored polycarbonate State Dent J 1985: 51 ;208-11. crown forms." These prefabricated pro 2 Rosentiel SF, Land MF. Fujimoto J. Con temporary Fixed Prosthodontics. 4 t h ed. Sl. visional restorations are limited to single Louis Mosby 2001 ;380-416. teeth Custom provisional restorations 3 Christensen GJ. Provisonal restorations for single crowns and fixed partial pros for fixed prosthodontics. JADA 1996, Vol 127. 249-252. thesis can be made from most of the .............4 ........: ,..1_

-I _

·~ · l l:.I' J PeriodontoI2002;73:1299-1307.

ABSTRACTS II~~~~~~~~~;;;===

The following abstracts were pro vided by the Department of Peri odontics at VCU School of Dentistry. We appreciate the contribution that these individuals have made to the Virginia Dental Journal.

J PeriodontoI2002;73:1360-1376.

Kalpidis C., Ruben M.

Treatment of Intrabony Periodontal De

fects With Enamel Matrix Derivative: A

Literature Review

The authors reviewed literature on

enamel matrixderivative use in periodon

tal regeneration. EnamellVlatrix deriva

tive (EMD) is thought to promote true

regeneration ofthe periodontalunit. This

belief is based on research showing

enamel matrix proteins (EMP) have a

significant role in the formation of the

periodontal supporting structures during

tooth development. Histologic studies

have shown that EMD is involved with

mechanisms required for cellular growth

and differentiation during tissue healing.

In vitro studies incorporating EMD have

shown superior bone growth, epithelial

downgrowth inhibition, and increased

POL formation. EMD guided regenera

tion (EGR) was shown to be equal to

traditional GTR in several studies. EGR

sites were shown to be stable over a 4

year period. There was however a wide

variability in the clinical outcomes re

ported in the various studies. The au

thors state EMD has been established

as a promoter of true regeneration, but

they note that the variability in the clini

cal outcomes points to other interac

tions that must be clarified.

Dr. Mark Zemanovich is a first year Periodontal Surgery resident at MCVNCU School of Dentistry. He received his D.D.S. degree from MCVNCU in 2002. - - - - - ~---------

Paolantonio M., Dolci M., Esposito P,

et al. Subpedicle Acellular Dermal Matrix Graft and Autogenous Connective Tis sue Graft in the Treatment of Gingival Recessions:A Comparative 1-yearClini cal Study Two methods of root coverage will be compared, Autogenous connective tissue(CT) or Acellular Dermal Matrix (ADM). The main advantage of ADM is that there is no additional donor site required. 30 systemically healthy pa tients with a Miller Class I or II gingival recession were treated for root cover age. 15 patients received ADM and 15 received CT. Clinical measurements were recorded at baseline and at 1 year post surgery. Both groups had signifi cant improvements in clinical param eters. The mean % root coverage (%RC) for CT was 88.8% and for ADM was 83.3%. Complete RC occurred 46% of CT sites and 26% of ADM sites. The CT group had significantly greater increase in keratinized tissue (KT). Complete healing after suture removal occurred at 6.2 weeks for the CT group and 8.9 weeks for the ADM group. In conclusion, both CT andADM treatment of class I and II gingival defects resulted in significant improvement of all clinical measures. CT group had more rapid healing and resulted in more keratinized tissue compared to the ADM group.

bined with bone graft material, has been shown to heal with increased density and also heal approximately twice as fast as Autogenous bone alone. 15 pa tients with a total of 24 maxillary sinus augmentations underwent the proce dure. After 4 months of healing, the implants were uncovered and loaded. Results showed that all implants were integrated at uncovery. Only 5 implants in 4 patients were 10s1. There was an overall success rate of 92.9%. Histo logical examination of the grafted sites showed that the new bone had similar or greater density than the native bone. In conclusion, PRP + Bi-Oss with si multaneousimplant placement offersthe advantage of shorter treatment time, 4 months rather than 12-18 months for traditional sinus lift and implant healing.

R. Lee Fletcher III is a second year Periodontal Surgery resident at MCVNCU. He received his D.M.D. from Nova Southeastern University in 2001. - - - ~ ------~

Int J Periodontics Restorative Dent 2002;22:323-333. Zucchelli G., Brini C., De Sanctis M. GTR Treatment of Intrabony Defects in Patients with Early-Onset and Chronic Adult Periodontitis

This study will compare the healing re sponse to GTR of patients classified as early-onset(EOP) and chronic adult Trang Salzberg is a first year Peri odontal Surgery resident at MCV! periodontitis(CAP). EOP, now termed Aggressive Periodontitis, is character VCU School of Dentistry. She re ceived her D.D.S. degree from MCV! ized by early disease (prior to 35), ge netic tendency, severe and rapid peri VCU in 2001. odontal destruction. 20 patients with - - - - - ~----vertical defects, underwent GTR with ti tanium reinforced membranes (Gore J Oral Maxillofac Surg 61:157-163, 2003 Tex), 10were classified as EOP and 10 Rodriquez A., Anastassov G., as CAP. Membranes were removed at 6 weeks. Patients were placed on Buchbinder D., et al.

Maxillary Sinus Augmentation with monthly recall. At baseline and at 1 Deproteinated bovine Bone and Plate year post surgery, clinical and micro let Rich Plasma With Simultaneous In biological measurements were taken. Results showed there was no significant sertion of Endosseous Implants

difference between the two groups. In The purpose of this study was to deter conclusion, vertical defects in aggres mine the success of the protocol: Com Sive-type periodontal patients will re bine platelet rich plasma (PRP) and spond similarly to GTR as CAP patients. deproteinated bovine bone (Bio-Oss)

Dave Johnson is a second year Pe with simultaneous placement of im ·'--'--+... 1 ~ .. r"Ar" rAcirt...nt ::It MeV!

VCU. He received his D.D.S. from the University of Colorado in 2001.

J PeriodontoI2002;73:1419-1426.

Goldstein M., Nasatzky E., Goultshein

J., et al.

Coverage of Previously Carious Roots

Is as Predictable a Procedure as Cov

erage of Intact Roots

P. gingiva/is was studied. Results indi cated P. gingivalis 381 induced foam cell formation, the precursor event to plaque formation. It was also shown that other periodontal pathogens had the same effect. In conclusion, peri odontal pathogens appear to induce plaque formation.

Steven Boone is a third year Peri odontal Surgery resident at MCVI VCU. He received his D.D.S. from The aim of this study was to investigate SUNY at Buffalo in 2000. Following the ability to treat previously carious completion of his residency, Dr. roots with Subepithelial connective tis Boone will enter private practice sue grafts (SCTG) for root coverage. 60 New York state. patients with gingival recession were

chosen consisting of 33 intact teeth and

27 carious roots. All recessions were

classified as Class I or II Miller defects. J PeriodontoI2003;74:175-180. Carious dentin and restorations were Miyazaki A., Yamaguchi T., Nishikata removed priorto the surgical procedure. J., et at. No root treatment other than hand scal Effects of Nd:YAG and C02 Laser ing was performed. SCTG surgery was Treatment and Ultrasonic Scaling on performed according to Langer and Periodontal Pockets of Chronic Peri Langer. Results were similar for both odontitis Patients root surfaces. Defect coverage was

92.4% for carious roots and 97.46% for The aim of this study was to compare intact roots. These results indicate that ultrasonic scaling(US) to two types of SCTG procedure is a predictable treat

laser treatments. It has been hypoth mentforClass I and II miller defects on esized that lasers may be more effec tive at killing bacteria and therefore may previously carious roots.

be better than ultrasonic treatment of root surfaces. 18 patients with 41 sites Bindu Reddy is a second year Peri odontal Surgery resident at MCV/ of >5mm were randomly assigned to VCU. She received her D.D.S. from either Nd:YAG laser alone, C02 laser alone, or US alone. Baseline, 1,4, and Columbia University in 2001. 12 week measurements were recorded, GCF samples were also taken. Re sults showed that Probing Depth de J PeriodontoI2003;74:85-89. creased significantly for all 3 groups. Kuramitsu H., Kang In-Chol, Qi M. The ultrasonic group and the Nd:YAG Interactionsof Porphvromonas gingiva/is groups showed a prolonged reduction of probing depth through 12 weeks. No with Host Cells: Implications for Cardio statistical difference in probing depth or vascular Diseases clinical attachment level was found The aim of this study is to investigate among the 3 groups. The C02 laser the role of the periodontal pathogen, P. group was less effective at removing subgingival plaque. In conclusion, gingiva/is in atherosclerosis (plaque for mation in the blood vessels). Recent Nd:YAG laser alone was as effective as research has proposed a link between ultrasonic scaling at reducing the clini periodontal pathogens and systemic cal signs of periodontitis over 12 weeks. atherosclerosis. Inflammatory response The authors suggest Nd:YAG treatment of roots may be appropriate for patients and bacterial interaction with host tis sue, are the two mechanisms by which who do not require ultrasonic scaling of periodontitis may be linked to plaque the roots. formation in blood vessels. The inter action between cell cultures of human Mark Brunner is a third year Perl endothelial cells and murine macroph odontal Surgery resident at MCVI age cells with the oertooontonatnooen V~II J-Ic rO,...fti"",,,,,,, a...:.- n no,... ..

The Ohio State University in 2000. Following completion of his resi dency, Dr. Brunner will enter private practice with Dr. Sugarman and Sugarman in Atlanta, Georgia.

Int J Oral Maxillofac Implants 2002; 17:854-860 Velasquez-Plata Diego, Hovey Lawrence R., et.al. Maxillary Sinus Septa: A 3-Dimensional Computerized Tomographic Scan Analysis Purpose of this study was to examine a cross-sectional sample of 312 si nuses in 156 patients using preopera tive axial CT scans (SIM/plant software), to determine the prevalence, size, lo cation, and morphology of septa in den tate, partially dentate, and edentulous maxillae. Of the 156 patients, 26% were completely edentulous, 73% were par tiallyedentulous. RESULTS: Frequency of septa: 75 septa were found in 312 maxillary sinuses (24%), and in 32.7% ofthe patients. 64 of the 75 septa were single septa, while 4 sinuses presented with 2 septa and 1 sinus had 3 septa. The septa were unilateral in 33 pa tients(64.7%) and bilateral in 18 patients (35.3%). Location of the Septa: 24% anterior region(mesial to distal aspect of the 2nd premolar), 41 % middle region(distal 2nd pre to distal 2nd mo lar), 35% posterior region(distal aspect of 2nd molar). Height of septa: Lateral region 0-15.7mm wI mean 3.54mm; Middle region 0-17.3mm wI mean 5.89mm; Medial region = 0-20.6mm wI mean 7.59mm. Those septa found in partially edentulous area had signifi cantly greater height than those found in completely edentulous areas. In con clusion, the frequency of septa in the maxillary sinus in this study was 24%, most septa are single, unilateral and in the middle of the sinus cavity.

Ben Overstreet is a third year Peri odontal Surgery resident at MCV/ VCU. He received his D.D.S. from MCVIVCU in 2000. Following completion of his residency, Dr. Overstreet will enter private practice with Dr. Maynard and Richardson in Richmond, Virginia.

The Virginia Meeting 2003 Schedule

Wednesday, September 10, 2003 11 :OOam - 4:00pm Executive Committee 4:00pm - 6:00pm Executive Council Thursday, September 11, 2003 7:00am - 5:00pm Registration & Ticket Sales 7:15am - 7:45am Credentials Committee 7:45am - 8:15am HOD Registration 8:15am - 10:15am Opening Session & HOD 10:30am - 5:00pm Reference Committees 12:00pm - 5:00pm VDHFNADPAC SilentAuction 5:00pm - 7:00pm Reference Committee Reports 6:00pm - 11 :OOpm ACD Dinner & Dance 7:00pm - 9:30pm Alliance Board Meeting Friday, September 12, 2003 7:00am - 5:00pm Registration & Ticket Sales 7:00am VDA GolfTournament Breakfast (Tournament starts at 8:30am) VAGD Breakfast 7:00am - 8:30am VDHFNADPAC Silent Auction 8:00am - 6:00pm 8:00am - 11 :OOam HIPAA - Protecting Your Privates Dr. Frank luorno & Josh Rahman, Esq. 8:00am - 11 :OOam Creating The Ultimate DoctorPatient Hygiene Exam Karen Davis, RDH, BSDH 8:00am -11 :OOam Why Didn't You Tell Me This Could Happen? Ms. Theresa N. Essick 8:30am - 11 :30am Life Would Be Easy If It Weren't For Other People Ms. Connie Podesta 8:30am - 11 :30am Helpful Hints For Building And Starting A New Dental Office Sid Alangae, Pauline Grabowski, Sid Jacobson, David Lionberger, Dave Luckenbaugh, & Jerry Price 8:30am -11 :30am Bioterrorism: Dentistry's Role In Recognizing And Responding To The Threat Dr. Louis G, DePaola 9:00am - 12:00pm Bullet Proof Crown And Bridge Dr. Larry Lopez 9:00am - 12:00pm Practice Transactions: A Step-By Step Strategy For Success Howard M. Rochestie, JD, LLM 9:00am - 12:00pm Perio Surgery For The General Dentist Dr. Jim Grisdale - Perio Institute 9:00am - 4:00pm VADPAC Shoeshine 9:00am - 4:00pm VDA Logo Shop Open 10:00am - 12:00pm Adult Heartsaver CPR Vivian Biggers, MSN, RNC, CDE 10:00am· 5:00pm Shopping Trip - Carytown/Grove 11:OOam - 6:00pm Exhibit Hall Open 11 :30am - 1:OOpm Fellows Luncheon 11 :30am - 1:30pm ACD Luncheon for Learning

1:OOpm - 4:00pm

1:30pm - 4:30pm 1:30pm - 4:30pm

1:30pm - 4:30pm

2:00pm - 4:00pm 2:00pm - 5:00pm

2:00pm - 5:00pm

3:00pm 4:00pm 4:30pm 4:30pm 6:30pm

- 4:30pm - 6:00pm - 6:30pm - 6:30pm - 10:30pm

(repeat of morning session) Vivian Biggers, MSN, RNC, CDE Creating The Ultimate Doctor Patient Hygiene Exam (continuation of morning session) Karen Davis, RDH, BSDH Removable Prosthodontics 2003: Meeting Patient's Esthetic And Functional Demands - Part I, Conventional Prosthetics Dr. Richard D. Jordan VAO Board Meeting Life Would Be Easy If It Weren't For Other People (continuation of morning session) Ms. Connie Podesta Dentistry & Pharmacology: Managing The Medically Complex: Practical Guidelines For Oral Health Providers Dr. Louis G. DePaola Constitution & Bylaws Committee Bullet Proof Crown And Bridge (continuation of morning session) Dr. Larry Lopez Perio Surgery For The General Dentist (continuation of morning session) Dr. Jim Grisdale - Perio Institute House Speaker Office Hours ADA 16th District Delegation VDSC Board Meeting VAGD Board Meeting VDA Party & Live Auction

Saturday, September 13, 2003 7:00am - 5:00pm Registration & Ticket Sales 7:30am - 8:30am ICD Breakfast 8:00am - 9:00am VAE Board Meeting 8:00am - 3:00pm Exhibit Hall Open 8:00am-11 :OOam How To Retire With Millions Darrell W. Cain 8:00am - 11 :OOam Dental Dilemmas: Bridging Theory And Practice Dr. Thomas K. Hasegawa 8:30am - 11 :30am Removable Prosthodontics 2003: Meeting Patient's Esthetic And Functional Demands - Part /I, Implant Support Prosthetics Dr. Richard D. Jordan 8:30am - 11 :30am Secrets of Practice Greatness Dr, Patrick Wahl & Ms, Lorraine Hollett 8:30am -11:30am Provisional Restorations That Fit, Function And Last: Hands On Training For The Dental Auxiliary Dr. Karen McAndrew 8:30am - 11 :30am Adhesive Dentistry - Materials & T/::Jr.hninues Simolified

9:00am - 12:00pm 9:00am - 12:00pm

Dr. Jeff J. Brucia Contemporary Pediatric Dentistry Dr. MichaelA. Ignelzi, Jr. Calcium Hydroxide & MTA (MmeroITrio~deAggrega~)And

Their Place In Modern Endodontics Dr. Raymond Webber 9:00am -12:00pm Bone Grafting & Guided Tissue Regeneration Dr. Jim Grisdale - Perio Institute VADPAC Shoeshine 9:00am - 4:00pm 9:00am - 4:00pm VDA Logo Shop Open 9:00am - 5:00pm VDHA Meeting & Lunch 10:00am - 11:OOam Handling In-Office Medical Emergencies Ms. Sherri Stein 11 :30am - 1:30pm Pierre Fauchard Luncheon 12:00pm - 2:00pm CDHS Lunch Meeting Handling In-Office Medical Emergencies 1:OOpm - 2:00pm (repeat of morning session) Ms. Sherri Stein 1:OOpm - 4:00pm How To Invest In Today's Economy Mr. Darrell Cain 1:OOpm - 4:00pm Bumps & Bruises Not Allowed Dr. Frank Farrington, Ms. Sonja Lauren, and Ms. Joanne Wells 1:30pm - 4:30pm Secrets of Practice Greatness (continuation of morning session) Dr. Patrick Wahl & Ms. Lorraine Hollett 1:30pm - 4:30pm Provisional Restorations That Fit, Function And Last: Hands On Training For The Dental Auxiliary (continuation of morning session)

Dr. Karen McAndrew

1:30pm - 4:30pm Adhesive Dentistry - Materials &

Techniques Simplified

(continuation of morning session)

Dr. Jeff J. Brucia

2:00pm - 5:00pm Successful Encounters With Kids

Dr. MichaelA. Ignelzi, Jr.

2:00pm - 5:00pm Bone Grafting & Guided Tissue

Regeneration

(continuation of morning session)

Dr. Jim Grisdale

Wine Tasting

3:00pm - 4:30pm Relief Fund

4:30pm - 6:00pm VCU School of Dentistry Reception

6:00pm - 9:00pm & VDA President's Party

Sunday, September 14, 2003 7:30am Past President's Breakfast 7:30am 2003 Life/50/60 Breakfast 7:30am - 9:00am Voting 8:00am - 9:00am Business Meeting & House of Delegates Registration 9:00am - 10:00am VDA Business Meeting 9:00am -11 :OOam Old Dominion Dental Society Meeting 10:00am - 1:OOpm House of Delegates 1:OOpm - 3:00pm Executive Council Agenda current as of July 2, 2003

Please refer to the meetino on-"itp

3/ Implant Innovations 3MESPE Accu Bite Dental Supply Accutech Orthodontic Lab, Inc. A-Dec AFTCO Anthem Blue Cross and Blue Shield Asset Protection Group, Inc. B&B Insurance Associates, Inc.' Bandit! Inc., Paul Belmont Equipment Benco Dental Company Biolase Technology, Inc. Brasseler USA John O. Butler Co. C&F Investement Services, Inc. Sonicare/Philips Oral Healthcare Caesy Education Systems Sullivan-Schein Dental Colgate Oral Pharmaceuticals SunTrust Merchant Services' ColiaGenex Pharmaceuticals, Inc. Sybron Endo Delta Dental Plan of Virginia VA Association of Free Clinics Den-Mat/Rembrandt VA Chapter - March of Dimes DentrixlVipersoft VA Dental Health Foundation Dentsply Caulk (Section 170 Plan) Dentsply Gendex VA Medicaid Take 5 Program Designs For Vision, Inc. VADPAC Direct Reimbursement' VCU School of Dentistry Discus Dental VDAAliiance Donated Dental Services VDA Logo Shop Doral Refining Corporation VDA Membership Drake Precision Dental Lab VDAA Garfield Refining Co. VDSC GC America Inc. GE Medical Protective' Great Impressions Dental Laboratories Healthy Communities Loan Fund HPSC Financial Services Instrumentarium Imaging, Inc. International Dental Group (Ident) KaVo America Corporation Kerr Corporation Legg Mason LifeServers, Inc. - Richmond, VA' MAMSI (Mid Atlantic Medical Services. Inc) Midmark Corporation M.O.M. Project New Image Dental Laboratory Nobel Biocare Northern Virginia Computer Solutions NSK American Corp. OMNII Oral Pharmaceuticais Oral-B Laboratories Orascoptic Paragon Patterson Dental Company Paychex' Planmeca, Inc. Porter Instrument & Royal Dental Group PracticeWorks/SoflDentIDICOM/Trophy Premier Dental Products Co Procter & Gamble Pro Dentec Professional Practice Consultants, Ltd. Professional Sale Associates, Inc. Professionals Advocate Insurance Co. R.K. Tongue Co. Inc. Rx Honing (Sharpening) Machine SciCan/Matrix SDI Sky Financial Solutions' Highlighted Exhibitors = Meeting Sponsors '=VDANDSC Endorsed Programs Paid Exhibitors as of Julv 2. 2003

[~~\i-'TC l-~

I, ~~

--.J

VADPAC and VDHF Silent Auction Thursday, Sept. 11 & Friday, Sept. 12

VADPAC Shoeshine

Friday, Sept. 12 & Saturday, Sept. 13

VDA Golf Tournament - Friday, Sept. 12 8:30am Shotgun Start Independence Golf Club - Midlothian, Virginia Your tournament package ;s just $120 which in cludes green fees, cart, continental breakfast, and lunch reception after the tournament. Attendance for this event is open to all registered attendees, spouses/guests, speakers, VIPs, exhibitors, and sponsors.

Wine Tasting

Saturday, September 13

3:00pm - 4:30pm

Have fun sampling Italian wines! $30

VDA Party - Friday, Sept. 12 6:00pm - 10:00pm Richmond Marriott Hotel FREE for all registered meeting attendees, spouses/ guests, speakers, VIPs, sponsors, and exhibitors Dancing, Food, and Live Auction to benefit VADPAC and VDHF.

President's Party - Saturday, Sept. 13

6:00pm - 9:00pm

Virginia Science Museum

Join Dr. Rod Klima for fun, food, fellowship forthe entire fam

ily! Entertainment includes a DJ, a country western singer,

and ajuggler! Watch one of the amazing IMAX movies.

4th Annual VDA Photography Contest

Dig out your cameras and old photos! All registered attend

ees are invited to enter the 4th Annual VDA Photography

Contest. The winning photo will appear on the cover of the

October issue of the VA Dental Journal.

Category

"For VDA dentists attending the VDA Annual Meeting for the first time. Discount available only if you preregister.

Category:

(spouse, hygienist, assistant, student, office staff, guest)

(first name)

(first and last name)

Name

_ (first name)

Category: _ (spouse, hygienist, assistant, student, office staff, guest)

Grand Total Tickets (from page 20)

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(payable to Virginia Dental Association) Please bill my credit card Credit Card # Expiration Date Name on card: Signature:

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Mail pages 19 & 20 to: Virginia Dental Association, 7525 Staples Mill Road, Richmond, VA 23228 Fax pages 19 & 20 to: (804) 261-1660 (must include credit card information) No telephone registrations will be accepted.

ame:

CC -~ 2 !,f;; :- I C !~ E T 5

iease mark number attending for all events, including "No Charge" programs.

F ~

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Date & Time

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!;::::;: ;~~:: (breakia~r~-~~'eakf~-=-r :~~;o~~~e.r:~~ ~. Friday @ 8:30am (golf) Friday @ 8:00am

, VDA GolfTournament

~uorno/Rahm·a~ses;on--

$120 --i---"'Badge'

·•. I ,

Friday@8:30am&1 :30pm _~~~~~~~e.ssio_n

--~'- --#

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i No Charge PM # - - '"

i Z~ ~~::: i

.1#--,AM # - - PM No Charge i

FridaY@8:30ami.Alangae/GrabOwski/JaCObSfln/i#INOCharei Lionberger,.... et al Session I Badge -+,- - - - - - - - - - - - iI- - - - gI . ._.-; .. --L.. Friday @ 8:30am & 1:30pm [DePaola Session ! Badge i # _ _ ,AM # _ _ No Charge. ,

-=...,-,._~~_:__-~~_.--.,

Friday @ 9:00am

Lopez Session

-!Rochestie

i Friday @ 9:00am & 2:00pm

-+i r

Friday @ 9:00am & 2:00pm

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CPR Session

I Fellows

; Friday @ 1130am

Badge

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$35

Lunch*

r II

,AM #

INo Charge' . 1$

I --- I

PM $

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Friday @ 1130am

!ACD Lunc~.:?~_~~_~earnin~+ __$40___l

Friday @ 1:OOpm

; No Charge I

Friday @ 6:30pm

Jordan Session

$30

I I No Charge i .

# _ _ PM

Badge

_____!

! Badge ! # INo charge:

satur~_ay_@ __~30~m ~D-Br-ea-~as~-_-.---,_-J-~:.I~lo:w~s~~O~n~l~y-1I--::--~#~===----_t_1 ~N~o~C~h~a~rg~e.

,! Saturday @ 8:00am & 1:OOpm i Cain Session ---J Badge i #--,AM # - - PM i No Charge .: Saturday @ 8:00am ' Hasegawa Session i Badge, # No Charge I

VDA PartL

Saturda~ @ 8:30am

._~-.::!.?rda~_~~~sion__,__.~.==~~--B~·

Saturday @ 8:30am & 1:30pm Saturday @ 8:30am & ,..,--

Wahl/Hollett Session

130p~-:__M~A~d·;~;-session

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,;VINE TASTING

_ _ _

_ _ person(s) @ $30 each = $ _ _

Sunday, September 14 10:30am (15 people limit)

Person Attending: Choice A:

Choice A: Choice B: Choice C

Saturday, September 13 3pm (40 people limit)

Person Attending:

_ _ _

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Choice A: Choice B: Choice C:

. # I$! , # _ _ ,AM # _ _ PM t No Charge i 1

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VCU School of Dentistry Re- $20 for adults # _ _ Adults # _ Kidsl $ i ception & VDA President Party $5 kids 6-17 # _ _ IMAX 7p m @ Science Museum of Virginia $6.50IMAX # _ _ IMAX 8pm I

.....

!3~~~ __ # _ _ ,AM # _ _ PM No Charge

:30a-;;;-_=~_==~-~~~;rr=!!_~~h~~~unch* ~._~~=:~_ =~~~s.,_=. Farrington/Lauren/ .__Y.Yl:!ll~__§_e~~l().n

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Saturday @ 9:00am

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r-Saturday@9:00am&2:00pm

Please make a reservation for _ _ people. Payment due directly to the Jefferson Hotel on the morning of the Brunch.

The following articles were sub mitted by speakers scheduled to lecture at the 2003 VDA Annual Meeting. To learn more, make plans to attend the 2003 VDA Meeting in Richmond from Sep tember 10-14. ---~-----

Friday, September 12

8am - 11am

Josh Rahman, Esquire

On August 14, 2002, The Department of Health and Human Services ("HHS") published in the Federal Register the Final Rule commonly known as HIPAA and formally titled "Standard for Privacy of Individually Identifiable Health Infor mation ("the Privacy Rule").' Due to the length of these modifications and the space restraint on this Article, the statu tory background and history of this leg islation will not be reviewed and read ers so inclined may refer directly to the Federal Register, volume 67 at page 53182 and following for all of the glori ous historical details. The Final Rule went into effect October 15, 2002, well in advance ofthe required Privacy Stan dard compliance date of April 14, 2003. In the Final Rule, there is a mixture of the proposed rules and additional clari fications and revisions that most cov ered entities will find helpful. There is still a great deal of work ahead of HHS on continued clarification, but the first step forward has been taken. As you read this article in anticipation of the seminar, you should keep in mind a couple of key definitions and one key fact. A covered entity is defined as any individual or group that provides or pays for health care. Protected health infor mation is any information that is re corded or oral that relates to the past, present or future health, condition, care or payment. Finally, the Privacy Rule is separate and distinct from the Security Rule and also separate from the Elec

tronicTransactionRequiremen~t:s.

Among other issues, HHS recognized the overly burdensome impact the pre vious accounting requirement imposed on covered entities. Accordingly, in the Final Rule HHS eliminated the account ing requirement for authorized disclo sures." A covered entity must secure an authorization unless the disclosure is required or otherwise permitted by the Privacy Rule itself. 3 Authorizations must meet the requirements of Section 164.508(b) and to the extent the autho rization does not meet those require ments, then it is invalid.' In order for an authorization to be deemed valid, it must contain the core elements and notifica tion statements contained in Section 164.508(c). We will further discuss these core elements and the right to revoke an authorization. We will also analyze how, in the Final Rule, HHS shifted the focus away from consent and onto Notice." Another focus of the seminarwill be the two types of disclosures under the Pri vacy Rule: permissive and mandatory. Further, we will look at the ability of a provider to disclose protected health information for the treatment activities of another health care provider. The seminar will also focus on issues related to incidental uses and disclo sures, how HHS strove to make the marketing provisions clearer and more practical, and Notices of Privacy Prac tices and acknowledgment by patients of receipt of the Notice

tion. This satisfactory assurance must be in writing either in the form of a con tract or some other type of agreement. 7 The Final Rule contains the sample pro visions for the business associate con tract in much the same format as pub lished in the March 2002 NPRM. HHS made three modifications in the section titled "Obligations and Activities of the Business Associate." The first set of changes permit the parties to negotiate terms relative to the protected health information. The second area is a clari fication that the business associate practices, books and records must be available to the Secretary and option ally to the covered entity. The previous version had mandated the material be available to the covered entity. The last modification was to clarify that the stan dard applicable to reporting by business associates of uses or disclosures out side of the agreement is the same as contained in the regulation. The requirements of the Privacy Rule are not onerous but do mandate that a covered entity establish policies and practices that will safeguard patient in formation to the extent reasonable. Patients are now federally vested with the right to request access to their in formation, to have copies made of their information and to obtain an account ing of disclosures. In addition, patients may request that communications oc cur in a confidential manner but the cov ered entity does not need to agree to the request. Finally, patients may also request to amend records, but they may not alterthe record. Thus, amendment will take the form of a written statement of the correction by the patient and that statement must be maintained with the record and in the same manner as the record.

Further, we will analyze the business associate relationship. That is, a busi ness associate is a person or an entity that performs certain functions or ac tivities that involve the use or disclosure of protected health information on be half of, or provides services to a cov ered entity." Thus any entity that pro vides services with access to protected For most covered entities, the Privacy health information that is not an em Rule is simply a formal recognition of ployee, is a business associate. The the practices and policies already in Privacy Rule requires that a covered place. The only added burden is the entity obtain satisfactory assurances publication of the Notice and the Policy from its business associate that the two along with the documentation that each sateuuard the protected health informs n.::tti,::.nt h~c::: hoon nnfifi£H'-' f""\n"""" .f.h,.. : ..... : ~ ~~~~~~~~~~~~~~~~~~~~~~~

tial period of compliance is concluded, business should proceed as usual. The next hurdle is compliance with the Se curity Rule published February 20, 2003. References: 1 67 Federal Register 53181 2 Section 164.528(a)(1) 3 Section 164.508(a) 4 Section 164.508(b)(2) 5 Section 164.506(a) and Section 164506(b) 6 December 3, 2002, Standards for Privacy of Individually Identifiable Health Information: OCR December 3, 2002. 7 General Provision under Business Associ ates - Standards for Privacy of Individually Iden tifiable Health Information: OCR December 3, 2002. --~-----

CREATING THE ULTIMATE

DOCTOR-HYGIENE PATIENT EXAM

Friday, September 12

8am-11am & 1pm-4pm

Karen Davis, RDH; BSDH

We've all been there. Frustrated! It seems as though the examination por tion of the hygiene visit often lends it self to increased stress. See if any of these scenarios sounds familiar: • The doctor wonders how many times he has to ask his hygienists to please have intraoral pictures displayed when he enters the room! e The clinical assistant and hygienist both want to ''wring the doctor's neck" since it took forever to get the doctor in hygiene, and now it's taking forever to get the doctor out! I!' The patient feels the tension from a feeling of being rushed, after waiting 10 minutes forthe doctorto complete a 2 minute exam! eo The administrator's neck muscles tighten as yet another patient com plains about the fee for the doctor's exam since, "She was only in there a minute, and besides, she said every thing was fine!" While there are many elements to con sider in creating an ultimate exam within the hygiene appointment, preventing these frustrations on a routine basis can be accomplished with entire team sup port. Here are a few considerations for achieving an ultimate experience. 1. Let go of the idea that a prophy laxis appointment is all the patient

In practice after practice, hygienists are desperately attempting to educate the patient, change behavior, scale all cal culus, remove all stain and plaque, per form and record periodontal evaluations, update radiographs, apply fluoride, iden tify restorative concerns, and so on, all in ONE appointment that lasts 45 - 60 minutes, IF you get started on time! Sound impossible? It often is. The American Dental Association has done a great job defining the difference be tween a prophylaxis, scaling and root planing and periodontal maintenance. If, during the appointment, data is collected for a periodontal diagnosis, it is easy to determine for which patients the prophy laxis may only the beginning of a treat ment plan!

2. Don't wait until the last five min utes of the appointment to have the exam In most busy dental practices, waiting until the hygienist is completely finished before notifying the doctor for an exam is almost a guarantee of running behind. Many times it is impossible for the doc tor to immediately leave a tedious or technique-sensitive procedure to go examine a hygiene patient. Having a hygienist notify the doctor once data has been collected and potential treat ment discussed will enable the doctor to look for a natural break in a proce dure, interrupt the hygienist during his or her treatment, perform the examina tion, then both return to completion of theirtreatments. 3. Use visuals to replace wordy de scriptions Patients will understand and retain in formation significantly better if audible and visual learning takes place together. Instead of us doing all of the talking (while working on the patient) and them being the captive audience, we should intentionally let the "pictures speak 1000 words" for us. Intraoral pictures, before and after pictures, educational pamphlets, radiographic pictures, etc., all assist in the co-discovery process necessary for patients to really desire what we recommend. 4. Sit the patient upright for com munication Contrary to how most of us commonly

willing to pause, sit the patient upright to describe conditions, discuss possible treatment, educate them with visuals, we find we actually have to say less, because the patient's ability to hear and retain information is significantly greater with the use of good eye con tact and body positioning. Sitting the patient upright also allows the patient to feel more comfortable and ask ques tions and enables us to become the lis tener. Most patients will not proceed with treatment until their questions have been answered!

5. Rise above insurance dictation Patients all across the country tend to approach dental decisions much the same way: "If insurance pays for it, okay. If not, no thanks!' (Particularly, if no symptoms are involved). Patient's questions concerning dental insurance should be consistently answered with a response that educates them about insurance reality. The reality is that dental insurance really is not "coverage". Dental insurance is simply assistance to help defray costs and all dental health decisions should be based upon need and desire, not simply insurance reim bursement determined by a contract. Having an ultimate experience does re quire planning and forethought and may include change for some, but the re wards of being deliberate about how we approach this important time allotment in the hygiene appointment can directly lower stress throughout the practice, increase the patient's understanding, and most importantly, improve case acceptance to achieve optimal clinical results we desire for all our patients. ~-----

"WHY DIDN'T YOU TELL ME THIS

COULD KAPPEI\!?"

Friday, September 12

8am-11am

Theresa Essick

GE Medical Protective

Risk Management Expert

Offers Insights

Based on Quality

Improvement Approach

"Risk management is about building ef £ _ _ .L:••

..J_ ...."':,..'" .... "" .. i n

n .. ral"'=l+innchinc::: "

says Theresa Essick, Vice President of Clinical Risk Management for GE Medical Protective. As a keynote risk management speaker during the Virginia Dental Association's Annual Meeting, Essick's presentation, Why Didn't You Tell Me This Could Happen?will focus on the preventive aspects of risk man agement. Essick, brings a strong clinical back ground to risk management. She has worked as an RN, has over twenty-eight years of experience in the health care industry, and is a certified professional Healthcare Risk Manager. Essick, leads GE Medical Protective's clinical risk management team. The company's endorsed carrier status with the Virginia Dental Association provides members access to Essick's knowl edge and experience, and her willing ness to help dentists and their staffs improve the elements of patient safety and satisfaction that are critical to suc cessful dental practices. "I really believe that so many disputes between doctors and their patients could have been prevented in the first place," Essick says. "As a risk man ager, I try to emphasize the processes that dentists can use to prevent error or variation in the way important tasks are implemented." Essick has also earned GE's Six Sigma designation as a qual ity improvement Green Belt.

Doctors who attend the presentation can qualify for premium credits by pur chasing a companion risk management home study, also entitled Why Didn't You Tell Me This Could Happen? GE Medical Protective insureds who suc cessfully complete the home study test, may qualify for a five percent premium credit for their next three policy renew als, as well as four hours of CDE credit. Order information forthe home study will be available at the seminar. For questions about the risk manage ment presentation, doctors can call the Virginia DentalAssociation at (804) 261 1610. ~._----

Friday, September 12

1pm - 4pm

Saturday, September 13

8:30am -11:30am

Richard D. Jordan, DDS, MS &

David Avery, COT

Her status as a quality improvement ad vocate will be evident in Essick's pre sentation as she examines communi cation issues and documentation prob lems from two important perspectives. First: How could proactive communi cation and/or appropriate documenta tion prevent problems from occurring in the first place? Second: Once the prob lem has occurred, what communication and documentation strategies could ef fectively resolve a dispute?

The number of people currently restored by full or partial removable dentures in North America totals 35 rniltion.' Other surveys predict that in the next 20 years the number of people overthe age of 50 will double as approximately 75 million baby boomers enter this age group making it comprise over 50% of the to tal population. 12 More importantly, they found that the current large population of removable prosthetic patients will dra matically increase during this time pe riod. In the past, the typical denture patient usually lost their teeth before age 30 and presented at this time with healthy, large residual rioqes.' Todaythe typical denture patient is older, presents with more compromised residual ridge situations but demand and can finan cially afford quality dental care.'

Why Didn't You TellMe This Could Hap pen? is scheduled for September 12, 2003, from 8 to 11 am during the Vir ginia Dental Association'sAnnual Meet ing. Registration is through the Virginia Dental Association. The program is appropriate for dentists and practice managers.

A classification of patient profiles based on their behavior to becoming edentu lous and their adaptation to complete dentures was developed by MM. House in 1950. 5 The classification had the fol lowing four categories: philosophical, exacting, hysterical and indifferent. Every clinician has hoped to have the

this group appreciates and will follow the dentist's advised diagnosis and treat ment. Patients in the other categories demand extraordinary effort by the cli nician with guaranteed treatment out come or are unwilling to try to adapt. More recently, there has been an ex pansion of the House classification to include "the behavior of the dentist as a co-determiner of the patient's behavior" Their patient type classification is as follows: ideal, submitter, reluctant, in different and resistant. As one can now gather, the patient-pro file changes far exceed the pace of tech nical advances regarding removable prosthetics. Furthermore, the graying population expands into groupings of those that are functionally independent, to the frail, to those that are function ally dependent.' Most denture patients expect new dentures to function better than their existing dentures. Because of this clinicians have always been chal lenged to make proper diagnosis and treatment recommendations. Today there is an additional challenge involv ing education of the patient to prepare them for the outcome for replacement dentures." 8. 9 "Patients will not accept solutions to problems they do not own. Case presentation is not about winning, it is about knowing the person and their mouth" (Dr. Lloyd M. Tucker, The Se attle Study Club, 2002). The aging population has many com mon characteristics which complicate treatment such as "decreased neuro muscular coordination, reduced ability to sense where the mandible is in rela tion to the maxilla (oral awareness) and impaired ability to position the mandible ortongue in desired locations (oral dex terity)." Institutionalized patient num bers are increasing as is the number of cognitively impaired residents in these settinqs." The management of these patients is difficult due to their inability to adapt well to change and the reduced ability to cooperate in their own case."

CLASSIFICATION SYSTEM FOR

COMPLETE EDENTULULISM

Since complete dentures are alloplastic devices that patients learn to use, clini cians must be aware of the landmarks

success. The first step is to examine and assess the patient's residual ridge morphology. The American College of Prosthodontists has developed a clas sification system based on (1) mandibu lar bone height, (2) maxillary residual ridge morphology, (3) mandibular muscle attachments and (4) maxillomandibular relationships. As bone heights and muscle attachments are lost, denture treatment evolves form simple treatment to complex treatment. Patient awareness to their individual situations and the expected treatment outcome is a critical educational pro cess. Proper diagnosis will determine which cases a general practitioner is comfortable to treat and which cases should be referred. Functional extensions of the prosthe sis are based on fundamental prosth odontics. Forthe mandibular arch, the primary force bearing areas are the re sidual ridge crest and the buccal shelves The retromolar pad is composed of firm connective tissue in its anterior half and resilient glandular tissues in the poste rior half. Since this area's height is fairly stable throughout a patient's life due to association with the attachment of the temporalis muscle, the denture is ex tended to the resilient part of the pad. The mandibular flange extension is fi nalized. The maxillary denture extensions are determined by recording the functional limits of the buccal vestibule and pay ing special attention to the posterior borders to insure coverage of the ha mular notches and the vibrating line.

COMPLETE DENTURE

IMPRESSIONS

Classically complete denture impres sions have included initial impressions (irreversible hydrocolloid/stock tray) and final impressions (polysulfide or polyvinylsiloxaine materials/ custom tray). Clinical studies have shown that the classic approach is difficult to teach and more difficult to apply. This has lead to an abbreviated impression tech nique in which the initial hydrocolloid impression serves as the final impres sion.? Duncan and Taylor found that the abbreviated technique was easier and

the 2 stage/selective pressure impres sion protocol. They had less remakes, less reline impressions required at de livery and a reduced number of patient treatment appointments. Since the development of the abbrevi ated technique by Duncan/Taylor, Massad and Connelly pioneered a static impression technique associated with a "simplified denture fabrication proto col" in 2000. This technique utilizes a high and low density irreversible hydro colloid materials. The functional flange extensions are predictably recorded during the impression process utilizing the injectable phase and tray phase materials that allow tissue border mold ing: Accu-Oent 1 Impression System by Ivoclar. This simplified denture fabri cation protocol applies to Classification I and Classification II cases. The sim plified technique reduces the number of appointments without altering the qual ity of the definitive prosthesis. Classifi cation I and Classification II cases, which range from ideal ridge heights and muscle attachments to cases with only localized soft tissue factors.

COMPLETE DENTURE

INTEROCCLUSAL RECORDS

TOOTH SELECTION

Fundamentals of record transfers and tooth selections are well established and will not be expanded on in this ar ticle. Anterior teeth have the best es thetic potential available to date incor porating natural tooth forms with color depth and translucency. Denture pa tients deserve the same optimal esthet ics that fixed prosthodontic patients demand and get.

ciency of mastication with an opposing non-anatomical tooth that simplifies the set-up and provides faster patient ad aptation via freedom of movement,FIG12 In addition a Iingualized occlusal format allows incorporation of a Curve of Spee and a Curve of Wilson that refines a fully balanced occlusal relationship providing better stability.

COMPLETE DENTURE PROCESSING Compression molded methylethacrylate acrylic resin has been the standard for the last 40 years. The literature docu ments undesirable dimensional changes (shrinkage) during the pro cessing procedure." 15 Today, many clinicians are taking advantage of an injection pressing method for process ing polymethlymetharcylate acrylic (Ivocap System by Ivoclar). This pro cess compensates for shrinkage occur ring during polymerization through a continual feed of material. The result is a better adaptation to the tissue bear ing area and insignificant observed changes in the vertical dimension of

occlusion." COMPLETE DENTURES:

RETAINING THE TREATMENT

PARAMETERS

Anteriortooth position is determined by speech ("S" sound of Silverman's clos est speaking space and "F" and "V" of the Pound technique). In addition the principle of "perfect imperfection" advo cated by Dr. Bob Stein of Boston is a standard incorporated in tooth sets to facilitate the natural esthetics.

The goal of all attention devoted to di agnosis, treatment planning and pa tient education regarding the limits of treatment is the delivery of an esthetic, stable, functional and "happy" denture. Patients have placed a great deal of trust in the clinician they chose fortheirtreat ment and have been a responsible team mate during the decision and treatment process. However, future changes in evitably occur during a patient's life. What can be done with changes that range from resorptive ridges, to the lost denture and to medical complications such as strokes, accidental trauma, normal aging or dementia? Can all the information established in making a happy, stable denture in the past be stored and not lost for a life time?

The posterior tooth selection advocated by most clinicians is a lingualized oc clusal set-up (Payne, Ortman and Pound). This combines the advantages of anatomic teeth in the maxillary arch

Once a denture has been fabricated, delivered and adjusted for comfort FIG13 , the anterior esthetics, the vertical di mension of occlusion, the interocclusal relationships etc. can be archived and

office. The archiving is done by a trained staff member in your office and the stor age responsibility is transferred to a pri vate company ( ALTADONICS in Win ston Salem, N.C.). This gives a patient the security of not having a dentist, origi nal or new, to "reinvent the wheel" in five years when a remake is indicated. The archived information can be trans ferred to a duplicate denture and deliv ered to the treatment dentist in 24-48 hours. The archived previous treatment information is captured in the duplicate as a "working custom tray" that at the 5 year remake first appointment allows the treatment dentist to (1) update the tissue bearing surfaces via a c1osed mouth reline impression, (2) reevaluate the esthetics and (3) reevaluate the ver tical dimension of occlusion and (4) make jaw relation records. In addition, just imagine the impact and reduction of stress when you are faced with treat ing a patient in your patient family who presents with a medical change which limits their ability to actively/predictably assist in the denture treatment process. This archiving process is invaluable with a "lost denture". Computers have the "save my documents section" for pull up of recorded information. Now den tists have THE ASSURANCE DEN TURE FOR LIFE (Altadonics). REFERENCES 1. The removable denture market survey, US Census Bureau 2000. 2 Douglas CW, Shih A, Ostay L Will there be a need for complete dentures in the United States in 20027 J Prosthet Dent 2002; 87;5-8. 3. Ivanhoe JR, Cibirka RM, Parr GR. Treating the modern complete denture patient; A review of the literature. J. Prosthet Dent 2002; 88;631-35. 4. Drake CW, Beck JD, Graves RC. Dental Treat ment needs in an elderly population. J. Public Health Dent. 1991; 51 '205-11. 5. House MM. Full denture technique. In Conley FJ, Dunn AL, Quesnell AJ, Rogers RM edi tors. Classic prosthodontic articles: a collector's item. Vol III Chicago American College of Prosthodontists 1978: 2-24. 6 Gamer S, Tuch R, Garcia LT MM House men tal classification revisited: Intersection of particular patient types and particular dentist's needs. J Prosthet Dent 2003; 89297-02 7 Ettinger RL, Beck JD Geriatric dental cur riculum and the needs of the elderly. Spec Care Dentist 1984 4'207-13 8. Budtz-Jorgensen E Prosthodontics for the Elderly Quintessence Publishing Co.. Inc Chicago. 1999. 9. Koper A. Why Dentures fail Dent Cline N Am 1964; Nov 721-34 10. Muller F, Link I. Fuhr K. Utz KH. Studies on

Oral stereogenois and tactile sensibility. J. What a puzzle! Not only do you won

of Oral Rehab 1995; 22:759-67. der if you have all the pieces, you ques

11. Petnokovski J, Harfin J, Mortavoy R, Levy F. tion if you even know what you want to

Oral findings in elderly nursing home resi create? The question becomes, how

dents in selected countries: quality of and satisfaction with complete dentures. J do you navigate through the intricacies

Prosthet Dent 1995, 73:132-5. of financial planning to implement a

12. Harrison H, Huggett R, Watson CJ, Beck comprehensive plan of action that actu

CB. A survey of complete denture prosthet ally works?

ics for the elderly, the handicapped and diffi cult patients. Br. Dent J 1992; 172:51-6. 13. Duncan JP and Taylor TD. Teaching an ab Develop a Game Plan

breviated impression technique for complete Establish life goals for your happiness,

dentures in an undergraduate dental curricu and convert the physical reality of these

lum. J Prosthet Dent 2001; 85: 121-125. 14. Wesley RC, Henderson D, Frazier QZ, et al, goals into monetary terms. What

Processing changes in complete dentures: lifestyle and monthly income do you

posterior tooth contacts and pin opening. J need? You should realize that this plan

Prosthet Dent 1973: 29:46-53. will change and develop as you gain

15. Heartwell CM, Rahn AD. Syllabus of com plete dentures. 3rd ed. Philadelphia: Lea & success and you will constantly adjust

Febiger, 1980. and reevaluate it. And remember that a

16. Strohaver RA. comparison of changes in plan that has stress with money is pref

vertical dimension between compression and erable to no plan and stress without

injection molded complete dentures. J Prosthet Dent 1989; 62:716-18. money.

ABOUT THE AUTHORS RICHARD D. JORDAN DDS, MS: Diplomate of the American Board of Prosthodontics, former Chair of the Department of Prosthodontics at the University of North Carolina, Clinical Asso ciate Professor in the Department of Oral Sur gery at Case Western Reserve University in Cleveland, Ohio retired after 10 years in private practice in Asheville, North Carolina. DAVID AVERY, COT: Director of Professional Services at Drake Precision Dental Laboratory in Charlotte, North Carolina. -----~-----

Saturday, September 13 8am-11 am & 1pm-4pm Darrell Cain, CPA Taxes, savings, costs, profit margins, good practice management, time man agement, investments, estate planning, insurance, how hard do I work, educa tion planning, pension plans, debt struc turing and the debt/tax spiral. Start a fire. Do you feel like the Billy Joel song, "I cannot take it any more?" Although dentistry along with its tech nical process is structured, it is still an art form. Having attorneys, insurance agents, pension administrators, invest ment advisors, brokers, practice man agement consultants, and accoun tants, all with their own plans, yet none of them working together, and possibly without a parallel vested interest of the doctor, often leads to confusion and in-

Understand the Basics

Educate yourself about how money

grows. Understand the cash flow of

your business and how it interrelates

with your taxes, debt structuring and the

assets you own.

Develop a Business Plan

Understand the time economics of your

dental practice. Understand direct costs

and fixed costs and learn to staff for your

slowest day, not your busiest day.

Charge a fee that is fair yet also allows

you to achieve success.

Get the Equity Out of Your Business

Do you know how to tap the potential of

your labor to build your business? Do

you know what is a fair arrangement for

you to create success with your asso

ciate? Do you know how to value the

business, how to split the money and

how to transition other doctors in and

out of the business? How do you shel

ter sales proceeds from taxes? Is a

sale worth it, emotionally, physically and

financially?

Understand the Impact ofTax Environ

ments

Compound interest earned in a tax de

ferred environment versus aftertax sav

ings growing in a taxable environment,

can lead to a 100% difference in the

amount you have to spend at retirement.

Do you maximize your pension plan and

put $50,000 to $90,000 awav each

----------------------

stand the math of geometric progres sion applied in harmony with all the other factors. When you do this, you will see that saving in a taxable environment at the same rate of return, over a 15 to 20 year time period, will yield only one half of the money you should have achieved.

-----~---

Reasonable Investment Plan Investments... Ouch! Would you not be better off spending your money? There are many important factors to consider. Have you configured your assets to take advantage of the two most important future economic events, demographics and rising interest rates? Do you invest your money with a tar geted rate of return and do you know if your target will achieve your plan? Do you increase or decrease your risk based upon your targeted return and your plan? Do you even have a plan? Remember that after every boom there is a bust, after every bust a boom! What made the most money in the past, is the past and the future of investments is a cycle.

Five-star service is not about hot tow els, muffins, or coffee bars. All of these things can be helpful, but service is re ally all about how your patients are spo ken to and treated by you and your staff. Patients can be treated like royalty with out any amenities, and they can be treated like chattel no matter how grand the buffet in the reception area.

Retirement Bad news, if you want to retire and live off your money you have to be a stu dent of investments and understand that investing pre-retirement and post-retire ment require different strategies. You must consider what will make you happy? Between age 30 and age 60, you accumulate money and then hope to live off this money during your retire ment years. How does this work? What is the plan for distributing money from the different tax environments? Do you spend too much money, or not enough money? How do you protect your as sets, use them for your benefit, and yet preserve them for your children? Questions. Questions. Questions Now that you at least know some of the questions have you sought a method to determine how your puzzle fits together? This does not happen by chance and there is no magic, only hard work and careful thought. Passion for the finan cial planning process is required to de velop your own financial plan and I would be happy to share my vision and expe rience with you during my lecture at the next Virginia Dental meeting. I hope to see yOU there!

'HE DEFINmON OF SERVICE Saturday, September 13 8:30am-11 :30am & 1:30pm-4:30pm Patrick Wahl, DMD, MBA & Lorraine Hollett, officemagic.com

Compare a real welcome, "Welcome to our office. We're glad you're here," with a mere, "May I help you?" Most impor tantly, ask every patient the defining question of your practice: "Is there anything that I can do to make your visit more comfortable today?" The words you don't use are just as important as those you do. Have you ever requested something of a store's employee, only to be told something about "store policy?" You probably didn't like the rest of the sentence, whatever it was. You probably felt treated like a child, like the times your parents told you, "Because I said so!" If there is a good reason for a policy, explain the reason in terms of the ben efit to the patient. If there is no reason for a policy, eliminate the policy. Phrase everything in terms of the benefit to the patient, and you'll never need to use the word "policy." Dr. Wahl once went to a very nice res taurant. "I didn't know that dinner jack ets were required. Luckily, the maitre d' knew something about good service, and he did not tell me, 'I'm sorry, sir, but dinner jackets are required here.' I wouldn't have liked hearingthat. Instead, he offered to loan me a dinner jacket, and explained, 'You'll be more comfort able.'" When a patient tells you to "submit this claim to my insurance company, and then bill me forthe difference," let's not

policy is to collect the fee at the time of service." Whatever that means, it sure sounds negative. Instead, explain to the patient that you have several different payment options available to help him. "Let me briefly describe them so you can choose which one is most convenient for you." A client of ours once told us that there were no payment options in his prac tice. To give a patient options, he ex plained, would be to tell the patient that there is a choice. "There should be no choice. They have to pay." We ex plained to our client that people who buy like to have choices. The key thing is to make sure that none of the choices rep resent any risk to your practice. When you purchase something, you want to see all the styles, all the col ors, and all the choices. Your patients are just like you and me. And the good news is that people who participate in the decision-making process are much more likely to comply with any agree ment. Five-star service means greeting pa tients by standing up and meeting them at eye level. Five-star service means shaking hands with every patient, even children. Five-star service means greet ing new patients with a tour of your fabu lous office (it only takes minutes), and not with forms! It's not the hot towel; it's how it's deliv ered. Compare the experience of an assistant shouting, "Here you go!" as she throws you a towel and runs out of the room with another who says, "Please take this towel to freshen your face. In dulge." Similarly, a coffee bar won't help if it's less than pristine. If you're not offering towels consistently to your patients, it may be because your team has found the process of keeping them ready to be a hassle. We've been impressed by the ComfortSpa ™ from Sharper Practice (800-392-1171, ''TLC'' Introductory Spe cial). It delivers a perfect towel every time with the mere touch of a button. You'll want to give one to and "wow" every patient.

Most of all, five-star service means de livering a great product on-time and with pleasure. As Dr, Paul Homoly says, "Every appointment is a case presenta tion appointment!" Every dentist says he or she gives great service. Few do. Call a few offices. See how you're treated. See how soon you can be seen. See if you feel cared about. It's easy to compete on service because so few others even try. Dr. Patrick Wahl and Lorraine Hollett have been called the "hottest speakers in dentistry." They will present "Secrets of Practice Greatness" at the Virginia Meeting on Saturday, June 13 th . They are the developers of the "Office Man ager in a Box" scripting system which helps you increase production and elimi nate office headaches. For more infor mation and to order, call (800) 750-8779, or visit their web site at www.officemagic.com . - - - - - ~-----

Saturday, September 13

1Oam-11 am OR 1pm-2pm

Pam Stein, DMD and Sherri Stein

Doctors when was the last time you really looked at the drugs in your medi cal emergency kit? Sometime today or this week find your kit and look at each little glass ampoule. You might be asking yourself: What is Talwin? And what is it used for? What about Wyamine? Or Aminopylline? The list goes on and on. Are you confi dent in your knowledge of the use of each drug? Probably not, why would you be? How often would you be called upon to use these drugs? However, if you have the drugs in your kit you have an obli gation, and in most states are required by law to know its use and dosage. What about dosages? If you had to ad minister the life saving drug epinephrine, what dosage would you give to an adult..; a 6-year-old child? Should you use a filter needle?

Preparing for medical emergencies can seem overwhelming and some will choose to take their chances, gambling it will never happen in their office. But, if an emergency does occur and you are poorly prepared, the consequences could be devastating. How then does the dentist be adequately prepared without a degree in emergency medicine? This course provides that information and the techniques for the dentist and staff to be ready to handle a medical emergency. We teach The Emergency Medical Protocol System. Researched and designed by Dr. Pam Stein, this system is an efficient and effective way for the dentist to take the steps needed to prepare for a medical emergency. The system is highly regarded within the dental industry, receiving acclaim from several nationally known organizations. "The Emergency Medical Protocol Sys tem revolutionizes the emergency kit," said Linda Miles, CEO of Linda L. Miles and Associates. "In today's busy world simplicity and detail are most important in saving lives. Quick thinking and the proper tools are essential. This emer gency system means peace of mind and a built in feeling of safety." Please join me, Sherri Stein at the Vir ginia Dental Association Meeting on Saturday, September 13 to learn "/jow

To Handle An In-Office Medical Emer gency". Protect your patients and your self.

Saturday, September 13

1pm-4pm

Sonja Lauren

Sonja Lauren, author of The Covered Smile will be discussing the topics of her newly released book during our an nual meeting. Ms. Lauren will be dis cussing the importance of good oral health, and the importance of reporting possible cases of child abuse and ne glect. She will also be showing slides which include the abuse and dental ne glect she endured as a child. Ms.

of twelve years and ten months old due to neglect; consequently, she has suf fered many painful, extensive surgeries and currently has only 20 % of her chew ing ability, She hopes by sharing her personal experiences, more profession als will become involved in reporting pos sible cases of abuse and neglect and also become advocates for children in need of dental attention. The foreword and a supporting chapter for The Covered Smile were written by Dr. Lynn D. Mouden DD.S., M.P.H., co founder of PANDA. Dr. John Ward D.D.S. ofVCU not only wrote a chapter on behalf of Ms Lauren's case, but has also provided much free dental care for her. Please visit Ms. Lauren's web site at www.thecoveredsmile.com. You may view her actual childhood dental records which read "situation-hopeless' as well as purchase the book if you wish. Currently Sonja Lauren is speaking with groups such as the VDA, VCU, and has been a guest on WFLO good morning radio talk show. Early in May, the Rich mond Times-Dispatch featured Mr. Lauren and Dr. John Ward DDS in their business section. The VDA and Opera tion Smile support Ms. Lauren's efforts to educate dental and medical profes sionals, and have added her book infor mation to their web sites. Mr. Lauren hopes by speaking about her intensely painful experiences, we will all better understand the importance of our pro fession as dentists and hygienists.

"", VIRGINIA~

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It is not too late to register for the 2003 VDA Meeting in Richmond' September 10-14,2003 Registration information on pages 19 and 20! For more information about the VDA meeting, call the VDA office at 800-552-3886

What's the reason for our

SUCCESS We could give you

,;;> •

of them.

Why is Delta Dental one of the leading and largest providers of dental care coverage in Virginia? A major reason is the participation

of 2400

of the finest dental care

providers in the state. Delta Denial was started by dentists, so it's only logical that we understand what works best for patients and dental care providers alike. At Delta Dental, our reputation is built on a tradition of success.

DELTA DENTAL DeltaDental PlanofVrrginia 4818 Starkey Road Roanoke, Virginia 24014 1·800·237·6060 www.deltadenralva.com

Stephanie Arnold, Director of Outreach Programs Monroe Harris Glenn Harrison Faryl Hart DDS would like to thank the following dentists, labs, Melanie Hartman Hartmann and funding sources for their help in 2002 - 2003. The Paul Steven Hearne program has been able to provide over $2 million in William Henry free dental care to 1,139 elderly and disabled Virgin足 Susan Heriford William Heriford ians. Carolyn Herring W.H. Higinbotham Lanny Hinson Jeffrey Hodges Neil Davis Hollyfield Neal Emad James Burden Kevin Honore Jeryl Abbott Corydon Butler Thomas Eschenroeder William Horbaly Jeffrey Ackerman Charles Cabaniss James Evans R. Leroy Howell Anne Adams Joseph Califano Michael Fabio Ralph Howell Jr. Randy Adams Claude Camden, Jr. Jackson Faircloth Raidah Hudson William Adams Robert Candler William Falls Christopher Huff Tony Agapis John Canter Gisela Fashing Wallace Huff MicheleAh David Cantor Kenneth M. Fauteux Douglas Hughes Elizabeth Alcorn Mehrdad Favagehi Jonathon Carlton Richard Hull John Alexander John Fedison Henry Cathey, Jr. Garrett Hurt Dandridge Allen Dana Chamberlain Bruce Hutchison Richard Ferris Elizabeth Allenchey Johnson Cheng Robert Flikeid David Inouye W.H.Allison Don Cherry Adam Foleck Jerry Isbell Lori Alperin Albert Citron Eric Foretich Raman Jassal Stephen Alvis Peter Cocolis, Jr. David Forrest L. Thornton Jett Bradley Anderson Karen Cole Harini Jindal Donald Francis Dave C. Anderson Norman Coleman Scott Francis Richard Joachim William Armour Robert Collins Gary Johnson Charlie French Kimberlyn Atherton Harry Conn Janet French H Phillip Johnson Carl Atkins Thomas Conner Agnes Fuentes David Jones Mitchell Avent Thomas Cooke Perry Jones Robert Futrell Charles Ayers Jennifer Copeland Ross Gale Tracy Jones William Babington Kenneth Copeland, Jr. Samuel Galstan Steve Kanetzke Jeff Bailey Michael Covaney Allen Garai Claire Kaugars Stephen Bailey Sharon Covaney William Gardner Jack Kayton James Baker Mark Crabtree Charles Gaskins Kanyon Keeney Raymond Baker James Keeton William D. Crockett Thomas Geary Howard Baranker Charlie Cuttino Garland Gentry Robert Kendig Richard Barnes Jeffrey Kenney Jeffrey Cyr Scott Gerard Velma Barnwell Ray Dail James D Geren M. Kerneklian John Bass Colleen Daley George Kevorkian Jr. Drew Gilfillan Richard Bates Stan Dameron Quincy Gilliam John Kim Gregory Bath William Davenport James Glaser Todd King Frank Beale Matthew Glasgow Jeffrey Day M. Kent Kiser Elizabeth Bernhard Damon DeArment Steve Goldstein John Kittrell David Bertman Timothy Golian Rodney Klima R. Cris Dedmond Edward Besner Bruce DeGinder Mark Gordon Deidra Kokel Hood Biggers Leslie Gore John Denison Michael Kokorelis Eliot Bird Suzanne Dennis M. Scott Gore Lawrence Kolter Stephen Bissell Shantala Gowda Clayton Devening Albert Kon/koff Jeffrey Blair David DeViese Daniel Grabeel Carl Block Robert J. Krempl Joseph Devylder Dave Graham Andrew Bluhm David Krese Surya Dhakar Ed Griggs Fred Krochma\ William Boland William Dodson Robert Grossman Michael Krone John Bonesteel Patrick Dolan John Grubbs John Krygowski Henry Botuck James Donahue Richard Gunn Sousan Kunaish Michael Bowler Steve Dorsch James Gyuricza Peter Kunec Reed Boyd John Doswell II Ronald Haden Michael Kuzmik Richard Boyle Ronald Downey Mark Hammock John Lacy James Bradshaw Alison Drescher Michael Hanley Peter Lanzaro John Bramwell Thomas Dunham Bill Hanna Paul Brickman John Lapetina Randy Eberly Peter Hanna David Larson Gerald Brown David Ellis Marvin Harman Daniel Laskin David Buckis

Michael Lavinder Thomas Layman W. Townes Lea Steven LeBeau Jesse Lee N. Ray Lee Timothy Leigh Tom Leinbach John Lentz Donald Levitin Fred Levitin GUy Levy Mayer Levy Micheal Link Jay Lipman B.A. Livick Clifford Lloyd Nick Lombardozzi James Londrey Melanie Love Lee Lykins, III A. Catherine Lynn Richard Macllwaine Alan Mahanes R.F. Mallinak Richard Mansfield Donald Martin Frederick Martin Shannon Martin Erika Mason Alfonso Massaro Brian McAndrew Karen McAndrew Allen McCorkle Michael McCormick, Jr. Henry McCoy Thomas McCrary Michael McMunn Michael McQuade Kenneth Mello H. Kyle Midkiff Kevin Midkiff Benita Miller Bob Miller Michael Miller Jan Milner Demetrios Milonas Lorenzo Modeste J. Peyton Moore Carol Morgan Gary Morgan Joseph Morgan Michael Morgan Kenneth Morris Neil Morrison James Mosey John Mosher Russell Mosher Thomas Mostiler James K. Muehleck David Mueller William Munn Peter Murchie Walter Murphy Naseer Naeem George Nance William Nanna

K.E. Neill J. Michael Nelson Jim Nelson PaulA. Neumann Joe Niamtu Ashley Nichols Kamran Nikseresht Clinton Norris James Nottingham Susan O'Connor Stuart Oglesby Thomas O'Hara Edward O'Keefe Edward M. O'Keefe Edward S. O'Keefe Robert O'Neill Michael Oppenheimer Michael O'Shea Alexander Osinovsky Bruce Overton Thomas Padgett Charles Palmer Russell Pape Steve Paulette Bonnie Pearson JimPell Joseph Penn Robert Penterson G. Thomas Phillips Michael Piccinino Jon Piche Todd Pillion Darryl Pirok James Pollard A. Carole Pratt McKinley Price James Priest Norm Prillaman Stephen Radcliffe John Ragsdale H.E. Ramsey III Shahla Ranjbar Eric Redmon Wayne Remington Philip J. Render Elizabeth Reynolds Thomas Richards Christopher Richardson Jacques Riviere A.J. Rizkalla Richard Roadcap Andrew Robertson Aurelio Roca John Roller John Rose Robert Rosenberg Scott Rosenblum Ronald Rosenthal John Ross Richard Rubino Scott Ruffner D. Gordon Rye Michael Sagman James Salerno John Salmon, "' Usa Samaha Stanhen S"rnff

Sharone Ward John Sattar James Watkins Anthony Savage WE. Saxon Benjamin Watson William Way Kevin Scanlan Richard Schambach Dennis Schnecker James Schroeder D.A. Whiston Alan White Harlan Schufeldt H.RamseyWhite Allen Schultz Miles Wilhelm Gary Schuyler John Willhide Jim Shearer William Sherman T.E.Williams Ted Sherwin Richard Wilson Richard Sherwood Barry Wolfe Richard Wood Earl Shufford Robert Siegel Roger Wood Royce Woolfolk Arthur Silvers Ronald Wray Robert Simmons Andrew Sklar Glenn Young M. Walter Young James Slagle Mark Young Matt Slattery Samuel Yun Peter W. Smith Richard Zechini Sherman Smock Kevin Snow Andrew Zimmer Edward Snyder Greg Zoghby James Soderquist Albert Solomon Steve Somers Robert Sorenson Christopher Spagna Richard Spagna Donald Spano Tracy Spaur Sebastiana Springmann James Stanley Douglas Starns R.E. Stecher AI Stenger G.A. Stermer Richard Stone Ken Stoner Matthew Storm C.B. Strange Robert S. Strange Frank Straus Kit Sullivan Richard Suter Kimberly Swanson David Swett Rebecca Swett Ralph Swiger Daniel Sykes Ron Tankersley John Tarver James Taylor Ned Taylor Donald Taylor, Jr. Ronald Terry Charles Thomas Andrew Thompson Damon Thompson William Thompson Vicki Tibbs Michael Tisdelle Philip Tomaselli Stanley Tompkins Donald Trawick Faith Trent Bradley Trotter Paul Umstott Eric Vasey J. Keller Vernon Greg Wall Jesse Wall

~~_m~.".

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--~_-----------------~

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Dentists: Please patronize and thank the following dental laboratories for their ongoing commitment and participation in the Donated Dental Services program.

: A New Generation Dental Studio Falls Church - (703) 533-5670 ATech Dental Lab Richmond - (804) 276-5158 Accutech Orthodontic Lab, Inc : Chesapeake - (757) 488-1919

. ; Acme Dental Lab Mechanicsville - (804) 559-8062 .: Albemarle Dental Lab " Charlottesville - (434) 296-3771

! Coleman's Dental Studio I

Fitz Lab

Richmond - (804) 359-4563

Richmond - (804) 276-8250

i! Crown & Bridge Dental Lab

Flexi-Dent, Inc.

Midlothian - (804) 897-2455

I Norfolk - (757) 588-1591

i Crowns By Colter

Fraguela Dental Laboratory, Inc

Virginia Beach - (757) 497-4166

i Charlottesville - (804) 975-5293

I i Custom Design Dental Lab i Roanoke - (540) 366-0710 I D. J. 's Dental Lab, Inc. i

Gibson Dental Designs Gainesville - (800) 554-5007 i'

Glendale Dental Lab, Inc

Newport News - (757) 877-9948 '

Salem - (540) 389-4329

I Allegiance Dental Lab i Dantonio Dental Lab Silver Springs - (301) 588-2218 I VA Beach - (757) 499-9559 I

Glidewell Lab

Newport Beach - (800) 854-7256

Aloha Dental Lab Lorton - (703) 339-7754

Gold Duster Dental Lab

Wytheville - (540) 228-3915

Andrew Dental Lab Falls Church - (703) 241-8666

: Danville Dental Laboratory

i Danville - (804) 793-2225

i Dental Laboratories, Inc.

Goodwin Dental Lab, Inc.

Richmond - (800) 476-4351

i Richmond - (804) 750-1188 I

Great Impressions Laboratory Richmond - (804) 282-6200

Arrident Lab Dental Prosthetic Services Inc Newport News - (757) 249-39001 Waynesboro - (540) 946-8435 Art Dental Laboratory Chantilly - (703) 378-8555

Bal's Dental Lab Arlington - (703) 405-0412

I Dickinson Dental Laboratory I

Haislip Dental Lab South Boston - (434) 575-7947

Buena Vista - (540) 261-1786

Hall Dental Lab Newport News - (757) 369-0664 ' ,

j Leesburg - (703) 777-1619

Baran Dental Lab Annandale - (703) 941-5099

Drake Precision Dental Lab : Charlotte - (800) 476-2771

Harris-Williams Laboratories Richmond - (804) 359-4697

Ben F.Williams Jr Dental Lab Richmond - (804) 233-8547

f Dramstad Dental Design : Leesburg - (540) 882-3602

Hermanson Dental Lab St. Paul- (800) 328-9648

! Biogenic Dental Corporation Utica - (800) 367-3322 Cardinal Dental Lab Williamsburg - (757) 220-2864

Carey's Dental Lab Mechanicsville - (804) 559-5159

East Dental Lab Hampton - (757) 723-3997

Ivory Dental Lab Falls Church - (703) 533-0600

Eden Dental Arts Eden - (336) 623-8284

J C's Dental Lab Hopewell- (804) 458-6246

Central Dental Laboratory

, Edge Dental Lab Elizabethton - (800) 917-8332

J Dent Lab Fairfax - (703) 352-2245

Ceramic StudiOof VA, Inc. Richmond - (804) 897-0801

Ernst Dental Lab , Poquoson - (757) 868-8978

James River Prosthetics Dental Lab Richmond - (804) 378-8887

Chilhowie Dental Arts Chilhowie - (276) 646-2869

First Impression Dental Lab . Vinton - (540) 345-5388

!:, Suffolk - (757) 934-0678 ,r

He's Dental Lab Fairfax - (703) 204-1333

, Dyna Tech Dental Lab i Charlottesville - (434) 974-1412 i

Coeburn Dental Laboratory Coeburn - (276) 395-2719

t ,

i Dominion Crown & Bridge Lab

~.â&#x20AC;˘'.:

Jetts Dental Laboratory , Falmouth - (540) 373-0119

First Impression Dental Lab Sandy Springs - (404) 252-2166 Jim Padget's Dental Lab Irvington - (804) 438-5369

Dentists: Please patronize and thank the following dental laboratories for their ongoing commitment and participation in the Donated Dental Services program.

John's Dental Lab

Terre Haute - (800) 457-0504

Precision Dental Arts

Twin Falls - (208) 733-0383

Thayer Dental Lab

Mechanicsburg - (717) 697-6324

Victor's Dental Lab

Falls Church - (703) 536-6604

Julian's Crown and Bridge Lab

Richmond - (804) 272-1446

Protech Dental Lab

Sterling - (703) 430-5556

The Tooth Works

Richmond - (804) 323-1511

Village Ceramics

Herdersonville - (800) 669-8361

Kastle Prosthetic Service

Clearwater - (800) 375-2391

Pulaski Dental Lab

Pulaski - (540) 980-6977

Tincher Lab

Charleston - (800) 225-4699

Virginia Dental Laboratories

Norfolk - (757) 622-4614

Kenneth Kellogg, COT

Washington - (202) 296-6090

Quality Dental Lab, Inc.

Virginia Beach - (757) 497-8211

TLC Dental Lab

Orlando - (407) 645-0344

Wagner Orthodontic Studio

Virginia Beach - (757) 481-9996

Kim Dental Laboratory

Richmond - (804) 674-9467

R & R Dental Lab

Salem - (540) 375-9311

Triangle Dental Lab

Triangle - (703) 221-1555

Walker Dental Lab

Decatur - (800) 727-0705

Kingsport Dental Lab

Kingsport - (423) 246-2220

Reston Dental Ceramics

Chantilly - (703) 449-0524

Tri-State Dental Lab

Jonesville - (276) 346-4055

Winegardner Dental Arts, Inc.

Norfolk - (757) 480-3520

Lab One

Norfolk - (757) 455-8686

Royal Dental Laboratory

Front Royal- (540) 636-1600

Universal Dental Lab

Richmond - (804) 282-9435

Zuber Dental Arts

Salem - (540) 387-4522

Luis Dental Lab, Inc

Falls Church - (703) 931-6447

Saunders Dental Laboratory

Roanoke - (800) 476-7319

Maplewood Dental Lab, Inc

Maplewood - (651) 779-7079

Saylor's Dental Lab

Manassas - (703) 631-1875

Master Dental Studio

Manassas - (703) 369-2628

Service Dental Laboratory

Lynchburg - (434) 237-1613

Messer Dental Lab

Grandview - (800) 523-5576

Sheen Dental Lab

Dunedin - (800) 322-2797

Midtown Dental Lab

Charleston - (800) 992-3368

Sherer Dental Lab

Rock Hill- (800) 845-1116

Modern Prosthetics Laboratory

Richmond - (804) 560-9000

Skyline Dental Lab

Charlottesville - (804) 973-9417

National Dental Laboratories

Alexandria - (703) 971-3133

Soon Dental Lab

Springfield - (703) 569-2979

Northern VA Dental LAb, Inc

Woodbridge - (703) 497-3500

South Boston Dental Lab

South Boston - (434) 575-6239

Nu Tech t.aboratones Midlothian - (804) 379-9939

Southern Gray Dental Lab

Stafford - (540) 720-6136

Southside Dental Laboratory

Peninsula Dental Lab

Newport News - (757) 599-3416 Chesapeake - (757) 548-4426

Pennington Crown and Bridge

Vinton - (540) 343-0434

Stanford Dental Lab

Blacksburg - (540) 382-7122

Pittman Dental Laboratory Gainsville - (800) 235-4720

Suburban Dental Lab

Rockville - (301) 881-2444

Plus Dental Lab Fairfax (703) 385 2125

Sven Tech

Fairfax - (703) 352-0969

SiGNiFiCANT NEW DEVELOPMENTS ON THE TAX FRONT David S. Lionberger, Esquire - Christian & Barton LLC President signs Jobs and Growth Reconciliation Tax Act

President Bush signed the Jobs and Growth Reconciliation Tax Act of 2003 into law on May 28. Highlights of the Act's tax provisions are: Individuals Increased child credit for 2003: For 2003 and 2004, the child credit increases to $1,000 per qualifying child (up from pre Act law's $600 per qualifying child for 2003-2004). After 2004, the child credit will drop back to $700 per qualifying child.

Marriage-penalty relief: For 2003 and 2004 only, the standard deduction and break points of the 10% and 15% in come tax brackets will be double those for single filers. For tax years begin ning after 2004, the standard deduction and rate brackets return to their 2001 levels. Accelerated reduction of tax brackets above 15%: For 2003 and thereafter, the tax rates above 15% are 25%, 28%, 33%, and 35% (under pre-Act law, the rates for 2003 above 15% were 27%, 30%, 35%, and 38.6%). After 2010, rates will revert to the pre-2001 levels. Increased AMT exemption amounts: For 2003 and 2004, the maximum AMT ex emption amount is $58,000 for joint fil ers and surviving spouses, $40,250 for unmarried taxpayers, and $29,000 for married filing separately, reverting to $45,000, $33,750, and $22,500, respec tively, after 2004. Businesses and Corporations Expanded expensing election: The fol lowing changes to Code Sec. 179 ex pense deductions are effective for prop erty placed in service in tax years be ginning in 2003, 2004, and 2005: • The maximum annual expensing amount is $100,000 (increasedfrom $25,000) The maximum annual expensing ~mnllnt

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.. •

(but not below zero) by any excess of the cost of qualifying property placed in service during the tax year over $400,000 (increased from $200,000) The above increaseddollar amounts are inflation-indexed for tax years beginning in a calendar year after 2003 and before 2006 Off-the-shelf computer software is now eligible for expensing Taxpayers may now revoke expens ing elections without IRS consent

Increased bonus first-year depreciation: Under prior law, a 30% additional first year depreciation allowance generally applied, after taking the 179 expense deduction, if: (1) its original use commences with the taxpayer after Sept. 10,2001; (2) the asset is acquired by the tax payer after Sept. 10,2001 and be fore Sept. 11, 2004, and (3) it is placed in service by the tax payer before 2005 (before 2006 for certain property with longer produc tion periods). The 2003Act provides an altemate elec tion for 50% bonus first-year deprecia tion for qualified property if: (1) its original use commences with the taxpayer after May 5, 2003; (2) the asset is acquired by the tax payer after May 5,2003 and before 2005 (there can't be a written bind ing contract for acquisition in effect before May 6,2003); and (3) it is placed in service by the tax payer before 2005 (before 2006 for certain property with longer produc tion periods). Note that there is no alternative mini mum tax depreciation adjustment forthe bonus first-year depreciation. This may impact a business' AMT liability when bonus depreciation is elected. Accumulated earnings tax and personal holding company tax rates reduced to 15%: Fortax years beginning after Dec. 31,2002, and before Jan. 1,2009, the ~rrilmlll~tprl

p::Irninnc: t::lY r::ltp ::Inri thp.

undistributed personal holding company tax rate on corporations are reduced to 15% (reduced from 38.6%). Collapsible corporation rules repealed: For tax years beginning after Dec. 31, 2002, the collapsible corporation rules are repealed. Reduced Rates for Capital Gains & Dividends Under prior law, an individual's adjusted net capital gain generally was taxed at a maximum rate of 20% for regular tax and AMT purposes (after paying tax at the 28% rate on collectibles and cer tain small business stock or at the 25% rate as recapture of deprecation on re alty). Gain from property held morethan five years that would otherwise be taxed at 10% was taxed at 8%, and gain from property held more than five years and the holding period for which begins af ter 2000, which would otherwise be taxed at 20%, is taxed at 18%. Divi dends received by an individual were taxed as ordinary income at rates up to 38.6% (for 2003).

Under the 2003 Act: • The 10% and 20% rates on adjusted net capital gain are reduced to 5% (zero, in 2008) and 15% respec tively, for both regular tax and the AMT, for sales and exchanges (and payments received) after May 5, 2003, and before Jan. 1,2009. • dividends received by an individual shareholder in tax years beginning after 2002 and before 2009 from domestic corporations (and certain qualified foreign corporations) are treated as net capital gain - the divi dends are taxed at rates of 5% (zero, in 2008) and 15% for both regular tax and AMT purposes. Certain special rules and exclu sions apply, including that the stock paying the divided must be held for more than 60 days during the 120-day period beginning 60 days before the ex-dividend date.

Planning under the 2003 Act The 2003 Act presents tremendous, but temporary, opportunities for businesses and professional practices to acquire more and newer machinery and equip ment with maximum tax benefits. The maximum 179 expense deduction is increased by four times to $100,000, and the income level at which phase out of the 179 expense deduction be gins is also doubled to $400,000. Fi nally, it is now clear that off-the shelf computer software qualifies for the 179 expense deduction. This expanded expense deduction is coupled with the new option to elect 50% bonus first-year depreciation for most capital equipment acquired after May 5, 2003, and placed in service before 2005.

tice acquires and uses a new $400,000 equipment package after May 5, 2003 that has a five-year depreciation recov ery period. For non-AMT tax purposes, the practice can now immediately de duct $100,000 of this cost under 179, plus an additional $150,000 (50% of the remaining cost under the bonus-first year depreciation rules), plus an addi tional $30,000 (the regular first-year double-declining balance depreciation allowance of $60,000 subject to the half year convention for the first year the property in placed in service). This is a total deduction for 2003 of $280,000, rather than the total deduction of $170,020 that would have been avail able under pre-Act law.

These changes mean many small and even some medium-sized practices can now fully deduct major equipment and software purchases, reducing the effec tive cost of the equipment and making purchase rather than leasing a more attractive option. For example, a prac-

RETURNING WITH A BRAND NEW COURSE:

Dr.

John

Kois

Presenting a Brand New "Advanced" Course critical to enhance the longevity

of your restorations, designed for Every Patient, Every Day in Every Practice.

This outstanding educator will present a new paradigm integrating a current

scientific basis for clinical practice without perpetuating existing dogma so you

can realize in advance the potential for disastrous results along with concepts to

minimize occlusal related failures As LAB ONE says, " The Choice is Kois ! "

"Functional Occlusion: Science Driven Management" Coming Friday and saturday, Feb. 6th &. 7th « 2004 at the New Norfolk Airport Holiday Inn Select Hotel! Priced at just $895.00, the course includes 16 AGD Approved Credit Hours,

Valuable John Kois Study Guide, Continental Breakfasts and Seated Luncheons Both Days !

NOTE: Special Reduced Rates available for your Practice Team Auxiliaries, and for out of town visiton Special Reduced Norfolk AiflKlrt Holiday Inn Select Hotel Accommodation rates have been arra~d!

Dr Kois Presentations are always a Sell Out I Assure yourself a place at this Important Course VIT AL to the Success of Your Practice'

CALL Tom Williford at LAB ONE Seminars

455-8686 or toll-free 1 (888) 448-7889 "Bringing the Very Best Continuing Education to the Dental Profession'"

• AppraisaJIVuluation Services

c.4!. Professional Practice --., Transitions"

• Associateships

Professional Practice Transitions (pPT) is pleased to welcome

Bob Anderson

• ContractServices

to its dental practice sale consulting team, With his manyyears of • PracticeBrokerage

experience working intheVIrginia marketplace, Bob has earned the trust andrespect ofVrrginia dentists.

• Non-Owner Practice Purchase Funding

As thepractice sale andconsulting division for Sullivan-Schein Dental, • PracticeManagement

PPTprovides a full range of practice brokerage, transition consulting, partnership andpractice appraisal services.

• Partnerships

Please call Bob Anderson at 804-379-6467 to • PracticeMergers

congratulate him on his new position and for a confidential discussion ofyour professional practice transition needs!

• Retirement Planning

Call PPT Today!

• Tax Planning

c.4!. Professional Practice --., Transitions" 425 Southlake Boulevard

• Suite B-1

• Richmond, VA 23236

Call 804-379-6467

Corporate Headquarters 1-800-730-8883

A Subsidiary of

~ Sullivan.~~~~_~~

Samantha Paulson, Director of Marketing & Programs Why A Direct Reimbursement Den tal Plan? Direct Reimbursement (DR) is a simple,

cost-effective method for employers to

provide dental health care benefits to

their employees. Whether the company

is large or small, these self-funded den

tal benefit plans can be designed to the

employer's specifications. DR plans

have been proven to save employers

money when compared with traditional

dental insurance plans.

the individuals who are making the in surance purchasing decisions for their business or company. Your role is to help us to identify those decision mak ers whom you feel will be open to dis cussing the benefits of DR.

If you are able to provide a referral or would like more information and promo tional materials about Direct Reimburse ment, please contact Samantha Paulson at the VDA Central Office 800 552-3886.

What Are The Advantages Of A DR

Plan?

Freedom of Choice: In a Direct Re

imbursement plan, employees are free

to choose their dentist without being

confined to choose from those on a pro

vider list. The dentist and the patient

determine the treatment plan without re

strictions or limitations.

Flexibility: Flexibility of plan design

allows the employer to control the level

of benefits in the plan. An employer may

choose to include a deductible and/or

an annual maximum benefit.

Cost: Plan costs are based on actual

dental expenses incurred, not on pre

mium payments made, regardless of

usage. Additionally, since a DR pro

gram is not considered "insurance,"

there is no premium tax liability.

Administration: An employer may choose to have a third party adminis trator (TPA) administer the plan, or elect to self-administer the DR plan. Either way, administrative costs are usually considerably less than with a traditional dental insurance plan. How Can You Participate In Promot ing DR? First, educate yourself and your staff about the advantages of Direct Reim bursement. Secondly, talk with your patients about their dental benefits plan. Each day you are in contact with pa tients, business organizations, and among this group of people you prob ably know at least one business owner

Having Troubles Collecting Your Receivables? Stamp out those unpaid bills! The Virginia Dental Association has

partnered with I.C. System to provide members

with intelligent collection solutions.

! U II.C. Systems, Inc, P.O. Box 64639 ,

•

I.CS)'STEM

St. Paul, MN 55164-0639

www.icsystem.com

Call Today! 1-800-279-3511

HELP rv~AKE "'(OUR OFFICE AN EVEN SAFER PLACE VV~TH AN AUTOMATEq EXTERNAL DEFI8R~LLA.TOR (AED) : Lisa Fratkin, LifeServers of Virginia LifeServers Inc. is a full-service plan The Virginia Dental Services Corpora

YOUR CHOICE tion has endorsed LifeServers Inc. of It Easy to use with it's simple 1-2-3 administrator. They will assist you with: step operation It Consultation and site assessment Virginia as the plan administrator for

Automated External Defibrillators ., Lightweight and compact - only 4 • Sale, delivery and set-up • Training coordination % pounds (AEDs). The Richmond based com

pany handles the distribution for ., Unique, cost-effective power sys ., Multiple-site coordination tem 1\ Data management of battery/elec Medtronic Physio-Control Lifepak prod

The newest, most USER trode replacement ucts.

• FRIENDLY,AED on the market .. Incident download, retrieval and What is an Automated External

communication to client L1FEPAK20 Defibrillator?

e' In service session with binder, op An AED is a device that analyzes and • Combines the AED function with erating/maintenance instructions & manual capability so that trained looks for shockable heart rhythms, ad

in service video vises the rescuer of the need for defibril

clinicians can quickly and easily ~ On-going relationship with dental deliver advanced diagnostic and lationand delivers the defibrillationshock

office for future training and product therapeutic care. if needed.

needs • Easily converts to manual mode A few shocking statistics • Easy to carry, maintain and service To implement an Automated External Cardiac Arrest occurs about 1000 • Data management capabilities de Defibrillator in your office, please call signed to meet your needs times every day and over 350,000 Natalie Guld or Lisa Fratkin at LifeServers of Virginia at 866-L1FE500. people are impacted every year • Flexible therapy options- non-inva sive pacing, electrodes or hard • It can happen to anybody, any paddles, docking station and pulse where, and anytime but despite our oximetry best efforts, only 5-10% survive na tionwide ., Time is critical... each minute of de lay before defibrillation reduces sur I The Virginia Services Corporation has teamed up ! vival by about 10% ! with Dell to offer VDA members special discounts and of- ii' • With the use of basic life support (CPR) and Automated External . fers not available to the general public. I Defibrillators (AEDs), survival rates above 50% have been achieved I Shopping with Dell's Employee Purchase Program has many!,

Dent~1

Here is what is available for your office L1FEPAK500 ., The tried and true choice - the AED most emergency response teams use • Simple 2-button unit designed for more frequent, rugged use Automatic self-testing and visible II readiness display helps assure you that your device is ready to go • Powered by a 5 year, non-recharge able lithium battery .. Weighs about 7 pounds

CRPLUS .. (>-

Rated the "easiest to use AED on the market" This unit can be designed to be fully automatic or semi-automatic -

. benefits. '.. ., • • • I.

VDA members receive a 5-10% discount on all consumer ma

chines (Dimension desktops and Inspiron notebooks)

5% discount on all consumer machines with a 1 or 2 year war

ranty

10% discount on all consumer machines with a 3 or 4 year warranty (on-site) Discounted shipping 24 hour Dell hardware telephone technical support Dell Preferred Account available to well qualified customers

:D:::::::'i~:::::: :::c:~::: advice or place an order . I r

by calling 1-800-695-8133 and speaking with a sales repre sentative. Be sure to mention our Member ID HS30392560 to receive the EPP discount. ______ ,.

~_,

Bruce MacArthur, Healthcare Compliance Service With today's awareness of environmen tal and health hazards associated with the improper management of waste amalgam, it becomes essential for a clear understanding of proper storage and disposal methods. All used, spent, or waste amalgam in any form or con tainer such as a trap, filter or capsule must be managed for proper disposal by sending it to a mercury recycling fa cility. This waste cannotgo to a landfill, sewer, infectious waste container, or metal recycler (unless that recycler spe cifically can recycle mercury). Below is a step by step procedure spe cific for the dental office to ensure total compliance with storing and recycling of waste amalgam, amalgam sludge, contact and non-contact amalgam, amalgam capsules, amalgam traps and filters.

ODetermine all locations within the dental office that containsamalgam/mer cury (new or used) Chairside traps Vacuum pump filters

facility. Make sure the company uses an approved facility for proper recycling. 8Keep all invoices and shipping docu ments in a specific file from the ship ping and recycling of this material.

Amalgam separators Precapsulated amalgam Elemental mercury in containers 8Establish a policy and procedure re garding daily, weekly or monthly service for these locations to ensure proper handling, storage and recycling man agement. Use containers specifically designed to handle waste amalgam for storage and shipping.

e Locate a company specifically de

signed to manage hazardous waste streams from the dental office that can ship this waste to a mercury recycling

Once these methods have been estab lished, the proper management of this material becomes relatively easy. "Cradle to Grave" responsibility of this waste falls upon the generator making it important to select the proper com pany for your waste management. The Virginia Dental Services Corporation (VDSC) has endorsed Healthcare Com pliance Service, a hazardous waste re cycling service company that offers a variety of services including amalgam/ mercury waste. See their adjacent ad vertisement in this issue for special VDA member discounts.

HCS

HEALTHCARE COMPLIANCE SERVICE INTRODUCES

WASTE AMALGAM FILTER AND TRAP RECYCLING SERVICE

With today's focus on the environment and hazardous waste, methods of disposal are becoming more restrictive and complicated. At HCS we offer proper waste management for all hazardous waste generated in the dental office. One of these

waste streams is found in the filters and traps of the vacuum pump system. These items collect amalgam particulate

from the patient once it has passed through the vacuum line prior discharge into the sewer. Amalgam once removed

from the patient is considered hazardous waste and must be managed as such.

When the filters and traps are removed and ready to be disposed, proper disposal methods must be in place. HCS

provides the storage container, return shipping container, proper documentation for disposal and the recycling service

all for one cost.

Let us manage your waste and give you peace of mind.

For more information on amalgam or other waste streams and to receive your VDA member discount contact us at:

Phone 610-518-5299 www.hcstoday.com

Fax 610-518-2995 E-mail hcstoday@cs.com

vosc

.I i .

PROUDLY PRESENTS OUR !'\fEVVEST ENDORSED VENDORS I C&F INVESTMENT SERVICES, INC & SUNTRUST MERCHANT SERVICESJ I ~ _

-_.

•

. -.

-_..

Samantha Paulson, Director of Marketing & Programs C&F INVESTMENT SERVICES, Inc.

fl·

C&F Investment Services, lnc., head quartered in West Point, Virginia, is a wholly owned subsidiary of Citizens & Farmers Bank, a community-banking firm established in 1927. C&F Investment Services, Inc. provides comprehensive investment manage ment, financial planning, and brokerage services exclusively through Raymond James Financial Services, Inc., mem ber NASD/SIPC.

Access to 6 different Wall Street research sources

For more informa tion please con tact: Doug Hartz, Assis tant Vice President/ Branch Manager 804-378-7296 888-435-2033

DeAnn Rinehart, Operations Manager 804-843-4584, 800-583-3863

C&F Investment Services, Inc. currently maintains over 1,700 accounts through out Virginia and 17 other states.

SUNTRUST MERCHANT SERVICES

The company offers a complete line up of investment and financial planning products, including: • Stocks • Bonds • Mutual Funds • Annuities • All types of retirement accounts • 529 college savings plans

Credit and debit card processing accep tance is essential for doing business to day. It's convenient for customers and efficient for you. SunTrust Merchant Services is uniquely positioned to pro vide you the very latest payment indus try technology, products and services. Its features and benefits include: 8?

In addition, the professional staff of the

firm provides management services in

cluding:

., Asset Management

• Estate Planning • Financial Planning • Retirement Planning

As a VDA Member you will receive the following benefits: • Customizedservice from designated liaison staff members with desig nated toll free phone numbers • Free internet access on all broker age accounts • Free checking • Discounted commission rates on stock trades • Easy to read monthly statements • Objective analysis on investment recommendations. (The firm is not associated with any product ven

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Fast authorization and Electronic Data Capture (EDC) via a high speed, fully redundant national transaction delivery system . Access to your funds within 24 hours with a SunTrust business checking account. A sophisticated chargeback de fense system that resolves a large percentage of all incoming chargebacks without debiting a merchant's account. This reduces the wait time for receiptof funds from outstanding claims. Reliable service with around-the clock point-of-sale support, 365 days a year.

Unsurpassed value at a competitive price. We provide high quality/high value merchant processing for all major credit, debit, stored value cards and checks.

VDA Members save on every trans action. ., No monthly minimum ., No monthly service fee • No application fee • New low rates Visa- 1.62% + $0.19 per trans action or 1.84% Mastercard- 1.62% + $0.19 per transaction or 1.84% • No reprogramming fee '" FREE supplies " Discounts on terminals Experienced Team of Experts SunTrust Merchant Services has a team of full-time payment industry experts serving clients across the Southeast and Mid-Atlantic regions. Our Account Executives are trained professionals with years of experience in the payment acceptance business. They act as your payment processing consultant and guide you through the most cost-effec tive payment solution - tailored to your business. For more information contact SunTrust Merchant Services at 877-488-8454 or visit their website at www.suntrust.com

IJJIf""C: .

There are a lot of "IMPQSTORS" outth.; to be as good asVitallium and some claim to be Vi The truth is only a few laboratories canprovide high . . . )., Vitallium Partial Dentures. There is only one Yitalliuni' and only a Vitallium Trademark Laboratory can pro with a Vitallium RPD. So beware ofthe "IMPOSr and make certain you are getting a genuin~ Vitalllum bylooking for theVitallium Shield oneveryc Your guarantee it's Vitallium! .~

The Name You Know路 The AUoy You Trust路 The Laboratories That Can

Goodwin Dental lab., Inc. 2110 Maywill St. Richmond, VA 23230 800-476-4351 /804-358-2113

zrrrrrr

Saunders Dental lab., Inc. 502 McDowell Ave, NE Roanoke,VA 24016 800-476-7319/540-345-7319

Haislip Dental lab., Inc.

Virginia Dental labs., Inc.

525 Wilborn Ave. South Boston, VA 24592

800-226-1839/434-575-7947

130 W.York St.

Norfolk, VA 23510

800-870-4614757-622-4614

For morp inform~jion on \'it~llillm ~lIov~ or thr \'it~llinm I,~hor~tor\' njl~r von i'~ll AmtpMl !It 1.~fifi.h11.01~1

VDA NEVifS

M.O.M. TEAM RECEIVES

VHCF AWARD

FIFTY YEARS OF FLUOR!DE The ADA recognized the following cit ies in VA as 2002 Community Water Fluoridation Award Recipients: Fries

Gate City

Norfolk

Norton

Portsmouth

Richmond

Suffolk

DR. SUSAN O'CONNOR

HONORED

The ADA recently honored Dr. Susan O'Connor of Independence, VA with a Certificate of Recognition for her Vol unteer Service in a Foreign Country.

Debbie Keller honored for her work with the MOM Project with the VDA:s Presidential Award presented by Ex ecutive Director, Terry Dickinson

Each year the Virginia Health Care Foundation (VHCF) recognizes out standing efforts that substantially ben efit various VHCF projects and their patients. The Mission of Mercy Coordi nating Team is the recipient of the 2003 Unsung HeroAward for Teamwork. The Unsung Hero Award is presented to the group of volunteers whose outstanding teamwork has been instrumental in ob taining extraordinary results for a VHCF project. This honor also goes to the 1,300 volunteer dentists, hygienists, dental assistants, dental students, hy giene students, and staff who offered their time and talents to the seven com pleted M.O.M. projects. Congratulations to the M. a.M. Team!

r------- '---'------', . i

THANK YOU

i' I, !

Dr.Anderson: I would like to thank you for the overwhelming generosity you've made in i i my behalf. Thank you for assisting I ! me with my educational goals and i . dreams. i I i I Last semester I earned a 4.0 and this i semester it appears that I may have I a repeat performance. I

, In January, I enrolled as a full-time student and the faculty at George. ! Mason University offered me a part- . . time teaching position in nursing. As I . you can imagine, the past semester i : has been rewarding and challenging. Again, thanks for your willingness to help me through such a difficult time . . Your generosity will yield great divi ~, dends.

t Sincerely,

/' Ms. Liz Howell

~:~~~:~~~fVDA2001 Victim Fund.

The picture was taken in the Governor's Mansion. Left to right: Dr. AI Stenger, Dr. William Viglione, Barbara Rollins, Dr. Terry Dickinson, Tina Bailey, Governor Mark Warner, Heather Tepper Simmons, Dr. Charles Cuttino, Dr. Carol Brooks, Dr. Bryan Brassington. Team Members not shown: Carol Diaz, Dr. Frank Farrington, Dr. Karen McAndrew, Kim Puckett, Dr. Roger Wood.

How many VDA Past Presidents during Pat Watkins' tenure as VDA Executive Di rector can you recog

The VDA Opening Session and 1st House of Delegates will take place at Visit the VDA website, 8:15am on Thursday, September 11 at www.vadental.org, to register on-line or the Richmond Marriott during the VDA call Barbara Rollins at the VDA central Annual Meeting. Issues will be dis office at 800-552-3886. cussed at Reference Committees on Thursday, September 11 at 10:30am Tidewater following the House of Delegates. All October 18, 2003 VDA members are invited to attend this meeting before matters go before the Eastern Shore VDA House of Delegates on Sunday, March 20-21, 2004 September 14.

The following dentists are running for VDA office. Electionswill take place at the 2003 VDA Meeting in September. President Elect - Dr. Bruce R. Hutchison Secretary/Treasurer - Dr. Edward J. Weisberg Councilor-At-Large - Dr. Ralph L. Howell, Jr. and Dr. M. Joan Gillespie ADA Delegate - Dr. Rodney J. Klima and Dr. Leslie S. Webb, Jr. ADA Alternate Delegates - Dr. M. Joan Gillespie, Dr. Ronald J. Hunt, Dr. Roger E. Wood, and Dr. William J. Viglione

There is a possibility of a $18 dues in crease.

Check out new items on the VDA website - www.vadental.org 2003 Virginia Meeting Information VDAHero VDA Committee Minutes Registration For Upcoming MOM Projects Classified Advertisements

Traveling Exhibit From October until December 2003, the Dr. Samuel D. Harris

National Museum of Dentistry will have a traveling exhibit at the

Children's lVIuseum of Virginia in Portsmouth, Virginia. For more

information, contact the museum at www.portsmouth.va.us/

childrensmuseumva orthe National Museum of Dentistry. Bring

the entire family for a day of fun with Brushella the Tooth Fairy

and learn all about the history of the toothbrush!

And Much More!

NEW

Member Benefit

Free HIPAA Help

To assist members in becoming compliant with HIPAA regulations, the ADA

legal division will provide an informational review of businessassociate agree

ments between members and practice management software vendors and

members and malpractice insurance carriers.

While the legal division cannot provide advise a memberto sign a contract or not, a contractual review from the ADA will provide the following:

tell members if the contract terms satisfy a dentist's legal obligations

under the HIPAA privacy rule.

identify any terms that are favorable to the dental practice - such as a

clause that requires the business associate to notify the dentist within

24 hours of an improper use or disclosure of protected health informa

tion.

Any member interested in obtaining a free review of their business associ

ate agreement should contact Nicole pugar at the VDA at (804) 261-1610 or

n.,,... ....../'::1\....... ....I ........... "-.....I

........,...

VADP'/J,C SUPPORTS PRIIVLb,RY ELECTiON VV!NNERS Nicole Pugar, Director of Public Policy The VADPAC committee was active this spring as the host of fundraising events held in support of candidates for the Virginia State Senate who faced primary opposition. The ef forts of the committee proved ben eficial as the candidates VADPAC endorsed defeated their primary opposition. On June 10,2003 Sena tor Tommy Norment defeated Paul Jost to become the Republican can didate for the 3rd Senatorial district and in the 27th Senatorial district, Senator Russell Potts defeated Mark Tate to become the candidate for re election in the Winchester area. Additionally, in the Fredericksburg/ Stafford County area, Senator John Chichester won the GOP nomination for the 28th Senatorial district by defeating Mike Rothfield. Senator Benny Lambert, who did not have primary opposition after his oppo nent decided not to run for office, is now seeking re-election in Novem ber. The first of four events was held at the home of Dr. Bruce DeGinder. Dr. DeGinder hosted a cocktail recep tion in honor of Senator Tommy Norment (R-3). A VADPAC chal lenge fundraiser, the committee agreed to match the amount the dentists of Senator Norment's district contributed to his campaign. In all, dentistry contributed over $10,000 including a $7,500 contribution from VADPAC.

Members of the VDA with Senator Tommy Norment

VDA President, Dr. Rod Klima, Mrs. Carol Klima, and Senator Potts

Dr. and Mrs. John Goodloe of Win chester were the hosts of the sec ond event for Senator Russell Potts. The dental community of the 27th Senatorial district and the VADPAC committed contributed $18,600 to the Senator Pott's primary campaign. Included in this total was a contribu tion from the VADPAC committee in the amount of $10,000. A recent article in the Winchester Star dis cussing the large amount of money Senator Potts has raised and spent, stated that VADPAC's $10,000 do nation to Senator Potts was one of the campaign's largest.

The third VADPAC fundraising event was held in the home of Dr. and Mrs. Joseph Niamtu. Drs. Randy Adams, Ralph Anderson, Richard Byrd, Charlie Cuttino, John Doswell, Barry Griffin, Monroe Harris, Michael Miller, Joseph Niamtu, Baxter Perkinson, and Roger Wood organized the event in honor of Senator Benjamin Lambert. The event was planned as an effort to assist Senator Lambert with a primary challenge, but be came a re-election event after his challenger dropped out of the race.

The VADPAC committee would like to commend Dr. Goodloe and his steering committee for all their ef forts. Senator Potts, who chairs the Senate Education and Health Com mittee, has consistently proven to be a friend of dentistry throughout the past 12 years of his service as a state Senator thus it is important that we support his efforts for re-election.

The VADPAC committee would like to sincerely thank Dr. DeGinder and his steering committee for all of their work. Thanks to their support it re mains possible that the dental com munitywill continue to have its friend, Tommy Norment, serve as a mem ber of the Virginia state Senate. Dr. John Goodloe, Senator Russ Potts, Dr

Robert Hall, Mr. Chuck Duvall, and Dr.

The VADPAC committee and the den tal community of the Richmond area contributed $10,000 to Senator Lambert's re-election campaign.

As all 140 members of the General Assembly face re-election cam paigns this November, the remain der of the year will certainly prove to be full of activlty, All members of the Association are encouraged to be come involved in VADPAC fundraisers in their area. As always, it is important that dentistry support lawmakers who make decisions that effect the profession and our pa tients.

Dr. Joe Niamtu, Dr. Baxter Perkinson, Dr. Eugene Trani, Senator Benny Lambert, and Dr. Monroe Harris

A fourth challenge fundraiser was hosted by Dr. John Coker and Fredericksburg area dentists at a local Fredericksburg restaurant. The dental community and the VADPACcommittee contributed over $10,000 to help Senator Chichester, President pro-tempore of the Sen ate and Chairman of the Senate Fi nance committee, win his primary re election campaign. The VADPAC committee contributed $7,500 to Senator Chichester's campaign.

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In addition to the challenge fundraisers, the VADPAC committee also made contributions to the fol lowing candidates. Both faced pri mary opposition and have been friends to the dental profession in the past.

For more information about VADPAC, please contact Ms. Nicole Pugar at the VDA Central Office at 804-261 1610 or 1-800-552-3886.

Delegate John Rollinson $1,000 Delegate Thomas Gear $750

Armed Forces Institute of Pathology

t . ·o~~ ;,~

Dr. John Coker and Senator John Chichester

SURGICAL ORAL AND MAXILLOFACIAL PATHOLOGY J with Microscopy Workshop

;;~ . '" .•. ~"o

20 - 22 October 2003 Hyatt Regency Hotel, Bethesda, Maryland This course is designed to provide a comprehensive review of the pathologic processes that affect the oral and maxillofacial areas, including major and minor salivary glands, jaws, and oral mucosa. Neoplastic, inflammatory, odontogenic, fibro-osseous, developmental, and metabolic diseases are discussed with emphasis on histopathologic criteria and clinical correlation that would aid a practicing surgical pathologist in establishing a diagnosis. Both lecture and microscopic slide review will be used. This course is appropriate for general pathologists, oral pathologists, residents, fellows, and other practitioners who are interested in the histopathology of oral and maxillofacial disease.

CLINICAL ORAL AND MAXILLOFACIAL PATHOLOGY 23 October 2003 Hyatt Regency Hotel, Bethesda, Maryland This course is designed to provide a broad-based review of clinical conditions in oral and maxillofacial pathology. Developing a differential diagnosis on the basis of clinical information will be emphasized. Radiographic conditions, soft tissue masses, ulcers, and pigmented lesions will be included. This course is appropriate for dentists, ora] and maxillofacial surgeons, ENT and otolaryngology surgeons, general pathologists. residents, fellows and other practitioners who are interested in the clinical aspect of diagnosing oral and maxillofacial disease.

For more information Please contact: Mark L. Hovland. Tel: 202-782-2637, Toll-Free E-mail: came@afip.osd.mil

rus

only): 800-573-3749.

2003 Graduating Class: Profile Dental Hygiene (16 graduates) 13 In private dental practice 2 In private dental practice and working toward master's de gree Enteringdental school in 2003 Dentistry (76 graduates) 38 In private dental practice 11 Advanced Education in Gen eral Dentistry (AEGD) 1 Entering full-time academics 4 General Practice Residency (GPR) 7 Military commissions and AEGD Military commission and En dodontics 6 Orthodontics 1 Oral and Maxillofacial Surgery (OMFS) 2 Oral and Maxillofacial Sur gery, one-year intemships 4 Pediatric Dentistry 1 Periodontics

2003 graduates D.D.S., dentistry

2003 graduates, dental hygiene -

Reunion Weekend 2003 Dr. James Revere re ceives the Harry Lyons Outstanding Alumni Award from Dean Ron Hunt.

On April 25, more than 400 dental and dental hygiene alumni returned to the MCV Campus to participate in alumni weekend reunion activities. The week end festivities began with a Friday evening reception hosted by the School of Dentistry and the MCV Alumni Asso ciation at the Richmond Omni Hotel. Approximately 200 alumni and friends attended the reception that officially commenced Homecoming Weekend 2003. Dr. P. D. Miller (class of '65), from Mem phis, Tenn., was the featured speaker at the Saturday morning continuing edu cation program. Miller presented a con tinuing education course on "Esthetic Crown Lengthening." Dr. Jim Revere (class of '65), was pre sented the Harry Lyons Outstanding Alumni Award. Revere, a faculty mem ber and administrator at the School of Dentistry for the past 35 years, plans to retire in July 2003.

Dr. Albert Konikoff (left) (class of '73) and Dr. P. D. Miller (cen ter) (class of '63) congratulate Dr. Brian Konikoff, (right) (class of '03) on winning the P.O. Miller Scholarship Award.

FACULTY NEWS Dr. Todd Kitten, Assistant Professor of Oral and Craniofacial Molecular Biol ogy in the Philips Institute, has been awarded a prestigious research career development award from the National Institute of Allergy and Infectious Dis ease. The NIH award will provide sal ary support overthe next five years, al lowing Kitten to devote 75 percentof his faculty effort to research. His proposal, "Streptococcal Genomics and Patho genesis," will allow him to broaden his research on the study of infective en docarditis,the heartvalve infectionmost often caused by oral streptococci. Kitten's work has implications for the development of a vaccine to control en docarditis.

Dr. Frank Macrina, Director of the Philips Institute, is completing his first year on the National Advisory Dental and Craniofacial Research Council of the NIH. He also is serving as the Council's representative to the NIH group that is drafting the new strategic plan forthe National Institute of Dental and Craniofacial Research. In addition, he was named to serve on the National Institutes of Health Panel on Oversight of Education in the Responsible Con duct of Research. Macrina will be one of the featured speakers at the annual summer meeting of the SouthernAcad emy of Periodontology. His presenta tion, "The Periodontist and the Human Genome Project," will conclude the meeting, which is being held in Asheville, N.C., in late June.

Dr. Harvey Schenkein received the 2003 Basic Research in Periodontal DiseaseAward, one of the Distinguished Scientist Awards presented by the In ternational Association for Dental Re search (IADR) at its meeting in Goteborq, Sweden, in June. Supported by the Colgate-Palmolive Company, the award was established to recognize, encourage, and stimulate outstanding research achievements in basic re search in periodontal disease. Schenkein, Assistant Dean for Re search, is an active researcher in peri odontal disease and has been the Di rector of the Clinical Research Center for Periodontal Disease at the VCU School of Dentistry since 1986.

Dr. Harvey Schenkein Dr. Todd Kitten

Dr. Janina Lewis, Assistant Professor of Oral and Craniofacial Molecular Biol ogy in the Philips Institute, has received an NIH Small Business Innovative Re search grant as part of her collabora tion with BioTraces, Inc., a Northern Virginia biotech company. Lewis is applying her scientific expertise to the new science of proteomics, the study of the full array of proteins produced by a cell. She is studying the behavior of pathogenic bacteria in both systemic and local infections. This research ef fort complements her active research program on the expression of virulence factors in the periodontopathic organ ism Porphyromonas gingiva/is.

Dr. Frank Macrina

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Join us on the high seas for the continuing education program, "Mem oirs of an Oral Pathologist," presented by Dr. John Svirsky. Our cruise will be aboard the Royal Caribbean International's "Enchant ment of the Seas," from Feb. 12 - 15, 2004. We will leave from Fort Lauderdale and visit the ports of Key West, Florida, and Cozumel, Mexico. Leisure time could be spent strolling through Key West's famed historic homes and gardens districts, basking in the tropical sun on a beach in Cozumel, or exploring the underwater world on a deep-sea adventure, Aboard ship, a variety of activities are yours for the asking, or simply relax and let the world drift by. Please book early to enjoy four days of continuing education opportunities and fun in the tropical sun. Call Beverly Saul, Covington International Travel, for cruise and travel arrangements at 804-747-4167 or toll free at 800-707-7717. Call Martha C, Clements, Director of Con tinuing Education, fortuition information at 804-828-0869.

ClaSSlfies

.......------------""

--~::-~

ads

Classified advertising rates are $40 for up to 30 words. Additional words.25 each. The classified advertisement will be in the VDA Jour nal and on the VDA Website - www.vadental.org. It will remain inthe Journal for one issue and on the website for a quarter (3 months) unless renewed. All advertisements must be prepaid and cannot be accepted by phone. Faxed advertisements must include credit card information. Checks should be payable to the Virginia Dental Association. The clos ing dates for all copy will be the 1st of January, April, July, October. After the deadline closes, the Journal cannot cancel previously ordered ads. This deadline is firm. As a membership service, ads are restricted to VDA and ADA members unless employment or continuing education re lated. Advertising copy must be typewritten and sent to: Journal & Website Classified Department, Virginia DentalAssociation, 7525 Staples Mill Rd., Richmond, VA 23228 or fax (804) 261-1660 The Yirginia Dental Association reserves the right to edit copy or reject any classified ad and does not assume liability for the contents of classified advertising.

X-RAY UNIT FOR SALE - ROANOKE

Gendex March 1998 with variable 60th second impulses, variable

kVp and will operate three tube heads. Call Dr.William Swann at 540

344-0750.

DENTIST NEEDED Free Clinic located in Christiansburg, VA seeks staff dentist to join award-winning Dental Program to provide general dentistry to unin sured, low-income patients. Full time, competitive salary, benefits, and a positive work environment. High quality of life in scenic mountains of southwest Virginia, with easy access to 1-81, Roanoke, Blacksburg, and VA Tech & Radford Universities. Direct inquiries to: Richard Pantaleo, M.Ed., Executive Director, Free Clinic of the New River Val ley, PO. Box 371 Christiansburg, VA 24068-0371 or 540-381-0820 or fcpsmc@naxs.net ROCKY GAP, VA ASSOCIATE DENTIST POSiTiON Surgical Skills NeededI Associate dentist position with patient oriented general practice limited to performing extractions, offering dentures, partials and related services. Lab is located on site. Good chairside manner is a must. Salary plus bonus. Paid health, life, liability insur ance. Continuing Ed provided. 401 K with matching funds. "Fill In" opportunities available. Call Brian Whitley 800-313-3863 ext. 2290 or email bwhitley@affordablecare.com , PRACTICES FOR SALE #7008, Gros~ $233,387; 45 days, 30peratories; 1200 sq. ft. office space, assistant, receptionist. condo office for sale with practice in professional park, Excellent potential. 100% financing available. Winchester Area: #7042, Gross $254,639; 4.5 days, 30peratories; 1200 sq. ft. office space, assistant, hygienist (pt), receptionist, Ex cellent potential, close to D.C., 100% financing available. Tappahannock Area: #7077, Gross $265,089; 3 days, 2 operatories: 850 sq. ft. office space, assistant (pt), receptionist (pt) Boat, sail, and grow with the beautiful people in the Northern Neck. Room for expansion., 100% financing available. Hampton #7007, Gross $406,640; 5 days, 3 operatories: 1600 sq. ft. office space, assistant, bookkeeper (pt), office manager, 3 addi tional plumbed but unequipped operatories, 100% financing available. Richmond: #7006, Gross $146,094; 4 days, 30peratories; 750 sq. ft. office space, assistant (pt), receptionist (pt), Excellent merger opportunity, 100% financing available. Northern #7035, Gross $608,006; 5 days, 5 operatories; 3700 sq ft. office space, assistant, additional plumbed but unequipped operatory, 100% financing available. Danville Area: #7018, Gross $310,365; 3.5 days, 4 operatories; 2150 sq. ft. office space, assistant (ft), assistant (pt), office manager; Beautiful office, large lot, computer system, Excellent potential, 100% financing available. For more information on any practice listed above, call Professional

I Williamsburg:

" t\SSOCIATE POSITIOf\' I\lE!,P, HARRISONBURG, VA • General dentist needed for an associate position leading to buy-out l of busy, progressive practice located in the beautiful Shenandoah Valley. Excellent opportunity; 22 year old family practice in fast grow t ing local community. Great earning potential. Contact Thomas M. LaTouche, DDS, 4167 E. Point Road, Elkton, VA 22827 or email I mosestom@shentel.net

WINCHESTER, VA ASSOCIATE DENTIST POSITION Surgical Skills NeededI Associate dentist position with patient oriented general practice limited to performing extractions, offering dentures, . partials and related services. Lab is located on site. Good chairside manner is a must. Salary plus bonus. Paid health, life, liability insur ance. Continuing Ed provided. 401 K with matching funds. "Fill In" opportunities available. Call Brian Whitley 800-313-3863 ext. 2290 or email bwhitley@affordablecare.com

CAREER OPPORTUNITIES Outstanding career opportunities in Virginia providing ongoing pro fessional development, financial advancement and more. Positions also available in FL, GA, IN, Ml, MD and PA. For more information, contact Jeff Dreels at 941-955-3150 or fax CV to 941-330-1731 or e-mail todreelsj@dentalcarealliance.com PRACTICE FOR SALE For sale, active dental practice in Virginia Beach. Large patient base with immediate cash flow. Owners retiring. Call 757-456-9700. DENTAL PRACTiCE FOR SALE Great opportunity available in great location. Well-established general practice with caring and well-trained staff. Willing to stay and work with new owner. Large office space, new building, new equipment, 4-fully equipped opertories. We are also seeking part-time general dentist that can work 1 to 2 days a week. Please contact B.J. at (757) 539-3735 or (757) 242-9888. REMINGTON, VA NEEDS SECOND DENTIST 3,300 sq. ft. medical/dental clinic for rent. Small town charm with growing housing market. Five thousand homes have been or to be built within five mile radius. Located on Old Route 29 near Route 17 . between Culpeper and Warrenton. Call owner at 703-201-6151.

I :

DENTAL PRACTICE FOR SALE Excellent opportunity in well-established general practice treating nice I' patients from 4-94 years old. Currently $270,000; 2 days/wk. w/ I additional days possible.. Fee-for-service, no managed care & less 1than 30% of Income from Insurance. Norfolk area. Send inquiries to Tidewater Dental Assoc., P.O. Box 887, Va. Beach, VA 23451

DENTAL EQUIPMENT FOR SALE AND/OR EQUIPPED s FUR· NISHED OFFICE FOR LEASE Wonderful opportunity for new graduate or established dentist. Con temporary four treatment room, 2450+ sq. ft. dental office available for lease August 2003. Located in well-established, well-maintained and easily accessible Professional Park in Newport News, Virginia. I. Newly carpeted, freshly painted. Laundry, dressing and shower area. Doctor building new office in new location. i, Dental Equipment (available with or without office): Adec equipment' & cabinetry, Reveal intraoral cameras, Adec, P&C dental lights, AI T2000 processor, x-ray equipment, Gendex panographic machine, i Various miscellaneous dental equipment, and Toshiba telephone system. For more Information, please contact: Dr. Lisa Marie Samaha @ [ 757/880-5156, Fax 757/249-0409 or e-mail [ samahadds@portwarwickdentalarts.com. Complete list of equipment, , with prices, available for review. .

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PAFFhlERSHIF lhi FR::m,=cilCt~SBURG Offered one-fourth Partnership in growing, thirteen year-old group General Dentistry Practice with collections of $2.79M and overhead ,..,f &:;"0/...

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What's So Special About Partials From Virginia Dental Laboratories?

Integrity. Virginia Dental Laboratory uses

• Vitallium® Alloy-the only partial denture alloy that is processed under the same quality control conditions as orthopedic implant alloy-with over 50 years of patient success.

Experience. The exceptional skills, quality • craftsmanship, and proven techniques of Virginia Dental Laboratories come only as the result of years of experience, painstaking effort and a deep commitment to integrity.

Accuracy. Our entire procedure for construct • ing Vitallium Partial Dentures is quality-con trolled to achieve the utmost accuracy. This accuracy means faster delivery of the restoration; reduced chairtime and greater patient satisfaction.

Commitment. Virginia Dental Laboratories is

• dedicated to providing you and your patients with the highest quality partial dentures available. We believe that the combination of our quality raw mate rials, such as Vitallium Alloy; our skilled technicians; our unequaled experience and our steadfast dedication specially qualify us to satisfy the needs of you and your patients.

Quality. Our partial denture restorations begin • with quality raw materials such as Vitallium® Alloy. Vitallium AlIoy® is totally biocompatible. It is nickel- and beryllium-free. Its surface won't tarnish, dull or corrode in the oral cavity or in the body.

For special treatment on your next partial denture case, please contact Virginia Dental Laboratories!

We are happy to survey. design and estimate from your diagnostic casts at no obligation to you! Contact us today'

Since 1932

irginia Dental Laboratories, Inc. 130 W. York Street Norfolk. Virginia 23510

1-800-870-4614

Call SkyToday...

800/ 890-3569

Endorsed By

DENTXTg~taRVICES f----Corporation-

All programs are subject to credit approval. Some restrictions may apply, including limits on the amount of personal and consumer debt that may be consolideted. 7103

Virginia Dental Association 7525 Staples Mill Road Richmond, VA 23228