Chairside Magazine Volume 15, Issue 1 by Glidewell

ONE HOUR OF FREE CE: Enhancing Bone Regeneration ❘ Dr. Randolph Resnik – p. 91

Implant, Restorative and Esthetic Dentistry

2019 Catch All the Highlights p. 17

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vol. 15, iss. 1

YOU INSPIRED

OF DENTAL INNOVATION IN OUR LAB.

HEREâ&#x20AC;&#x2122;S TO ANOTHER HALF-CENTURY OF PROGRESS.

PUBLISHER’S LETTER

Education: The Key to Growing Your Business in 2020 and Beyond

I In 2020, we’re stepping up our commitment to helping dentists grow their practices.

’ve long believed that when a business stops pursuing growth, it signals that the death of that business is soon at hand. Sharpening skills, offering expanded services and refining core competencies are paramount to keeping an enterprise vital, which, as a business owner, should be important not only for yourself but also for the future of your employees and patients. However, growth is expensive and difficult. At Glidewell we just completed our 50th year of operations, a feat achieved by continually reinvesting in the business, gathering knowledge from other industries, and turning to technological innovation wherever possible — efforts that ultimately enable us to provide faster, higher-quality and more affordable service offerings to dental professionals across the nation. But we recognize that the everyday practitioner may not have the same opportunities to pursue growth as we do in our laboratory. So, in 2020, we’re stepping up our commitment to helping dentists grow their practices. I am excited to announce the launch of our new and improved online education platform, which is now available at education.glidewelldental.com. There, you’ll find world-class courses on a wide array of topics, from practice management, to crown & bridge, to implant placement, and more. These brand-new courses are taught by widely acclaimed

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experts, and showcase the subject matter in an interactive, accessible format. Best of all, these online classes are completely free. I encourage you to experience this new web platform for yourself. I’m certain you’ll find that it offers one of the simplest methods of earning continuing education credits and learning new skills that can help you broaden your practice’s offerings. For clinicians who prefer to expand their skills in person, in 2020 we’re hosting an expanded range of courses at premier education facilities across the country, including the Glidewell Clinical Education training centers in Irvine, California, and Louisville, Kentucky. Further, we’ve partnered with some of the most respected education institutes in dentistry, including the Misch International Implant Institute, to ensure that clinicians gain knowledge that’s immediately usable in the dental practice. And we’ll continue our tradition of offering can’t-miss education events by hosting the fourth annual Glidewell Symposium in November, which offers two days jam-packed with practical clinical and business education. New this year is the Guiding Leaders Summit in April. This event is designed specifically for women and offers clinical and leadership training. By providing these educational opportunities, we hope to reduce the number of barriers dentists face to achieving practice growth. And together, with renewed knowledge and skillsets, we can expand the reach of dental care to more patients in need.

Sincerely,

Jim Glidewell, CDT President and CEO, Glidewell

TABLE OF CONTENTS KEY EVENTS

EDUCATION

DENTAL SLEEP MEDICINE

106

Third Annual Glidewell Dental Symposium: A Weekend of Clinical Education

Glidewell Presents Free Online CE Courses

Why Every Dentist Must Screen for Sleep-Related Breathing Disorders

Catch a glimpse of why this event has doubled in size every year since its inception, becoming one of the most popular CE events in dentistry.

73 Interview with Stephenie Goddard: An Inside Look at the Guiding Leaders Summit 2020 Discover how this upcoming two-day conference designed for women in dentistry will help shape a new generation of leaders.

Find out how to make the most of the exciting new CE content available at education.glidewelldental.com.

25 Glidewell Dental Symposium 2019: Answers to Audience Questions

69 My Transformational Journey as a Guiding Leader Dr. Jill Frazier

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Drs. Ken Berley and Jesse Teng â&#x20AC;&#x201D; Expectations are changing for dentists in the screening of patients for snoring and obstructive sleep apnea.

92 Dental Sleep Medicine: Should You Become a Medicare DME Supplier? Randy Curran and Kyle Curran â&#x20AC;&#x201D; The path to reimbursement for dental sleep appliances leads to considerable benefits for patients and dentists alike.

IMPLANT DENTISTRY

RESTORATIVE DENTISTRY

DENTAL TECHNOLOGY

Enhancing Bone Regeneration with the Use of Platelet Concentrates

Smiling from the Inside Out: Restoring a Smile After an Eating Disorder

R&D Corner: Utilizing AI to Produce Better Crowns, Faster

Dr. Randolph Resnik — Don’t miss this comprehensive look at a highly beneficial procedure that can accelerate hard- and soft-tissue healing at implant sites.

Dr. Susan McMahon — Giving patients back their smiles can renew far more than dental health and esthetics.

My First 60 Days: A glidewell.io™ Practice Report

Common Problems with Digital Impressions — and How to Avoid Them

One hour of free CE is available for Dr. Resnik’s article. See page 91 for details.

43 Implant Surgery: When Should You Use a Flapless Technique?

Dr. Sergei Azernikov

Dr. Timothy Kosinski — Choosing between flap reflection and a flapless surgical procedure can be a simple decision if you know the guidelines to follow.

Dr. Justin Chi — Have you experienced issues with your intraoral scans? Here are some tips and tricks to help get your digital impression right the first time.

By the Numbers

An Inside Look at Implant Dentistry’s Essential Textbook Dr. Randolph Resnik

New Technology: Practice Disruption or Increased Production? Carrie Webber

ALSO IN THIS ISSUE

101

Letter to the Editor

6 8

My First ‘Emergency’ Implant

115

Education Corner

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Product Spotlight

BruxZir Celebrates 112 10 Years Strong ®

Employee Spotlight

ON THE WEB Here’s a sneak peek at additional Chairside magazine content available online

PUBLISHER Jim Glidewell, CDT EDITOR-IN-CHIEF Neil Park, DMD CLINICAL EDITOR Jack Hahn, DDS EXECUTIVE EDITORS Grant Bullis, Greg Minzenmayer, Eldon Thompson MANAGING EDITOR Bobbie Norton, RDA CREATIVE COORDINATOR Jennifer Gutierrez CONTRIBUTING COPYWRITERS/EDITORS Aleesha Chaney, Danny Evans, Ilona French, Kathryn Lukaske, Chris Newcomb, Brenda Paro, Keith Peters, Adam Pringle, Michelle Raddatz, Bradley Zint GRAPHIC DESIGN TEAM LEAD Joel Guerra GRAPHIC DESIGNERS/ILLUSTRATORS Emily Arata, Terri Blake, Carla Butz, Tony Hsiao, Cheryl Joaquin, Audrey Kame, Dennis Lee, Phil Nguyen, Kelley Oh, Tony Tran, Mike Trujillo, Makara You

ONLINE VIDEO PRESENTATIONS ■

■

I f you missed the 2019 Glidewell Dental Symposium, don’t miss our recap of all the highlights — and be sure to visit glidewellsymposium. com for information on our 2020 symposium taking place Nov. 6–7 in Anaheim, California.

■

re you taking advantage of the A speed, cost savings and accuracy of digital impressions? If so, don’t miss Dr. Justin Chi’s tips and tricks for avoiding errors with intraoral scans.

he inaugural Guiding Leaders Summit — a weekend of continuing education T and professional development created exclusively for female dental professionals — is taking place April 24–25 in Huntington Beach, California. Check out our sneak peek at what attendees can expect at this one-of-a-kind event.

WEB DEVELOPER Meng-Jung Hsieh PHOTOGRAPHERS/VIDEOGRAPHERS Kyle Frager, James Kwasniewski, Sam Lea, Andrew Lee, Mariela Lopez, David Manahan, Crystal Nguonly, Marc Repaire, Stanford J. Southall, Sterling Wright, Maurice Wyble COORDINATORS/AD REPRESENTATIVES Michael R. Martinez, Maria Ramos

chairsidemagazine.com Chairside magazine is optimized for all popular desktop, tablet and smartphone platforms. Go online to view the latest digital edition from your computer or favorite mobile device.

ONLINE CE CREDIT Free continuing education credit is available online for Dr. Randolph Resnik’s article “Enhancing Bone Regeneration with the Use of Platelet Concentrates.”

Visit chairsidelive.com to view the latest episode of our weekly web series “Chairside Live.”

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Neither Chairside magazine nor any employees involved in its publication (“publisher”) make any warranty, expressed or implied, or assume any liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represent that its use would not infringe proprietary rights. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer or otherwise does not necessarily constitute or imply its endorsement, recommendation, or favoring by the publisher. The views and opinions of authors expressed herein do not necessarily state or reflect those of the publisher and shall not be used for advertising or product endorsement purposes. CAUTION: When viewing the techniques, procedures, theories and materials that are presented, you must make your own decisions about specific treatment for patients and exercise personal professional judgment regarding the need for further clinical testing or education and your own clinical expertise before trying to implement new procedures. Chairside is a registered trademark of Glidewell.

EDITOR’S LETTER

The formula is simple: Provide great clinical education on the topics of greatest interest to general dentists, keep the tuition affordable, and host it at a great location.

ur job at Chairside® magazine is to present clinical techniques and practice management information that will make dentistry more rewarding for you. As part of that mission, we also try to point you toward additional educational opportunities that will help you reach your goals.

Dr. Susan McMahon provides an inside look into the ravaging effects of eating disorders, followed by the extraordinary solution that brought one patient from deep devastation to a smile filled with joy. For more information on the Guiding Leaders Summit, or to apply for the 2020 program, visit guidingleaders.com.

The third annual Glidewell Symposium was held this past November in Orlando, Florida, hosting more than 1,000 dental professionals. We appreciate your enthusiastic embrace of this meeting and your support for our third consecutive sold-out event. The formula is simple: Provide great clinical education on the topics of greatest interest to general dentists, keep the tuition affordable, and host it at a great location. If you missed it last year, check out the highlights in this issue, and plan to attend this year in Anaheim, California. Visit glidewellsymposium.com for information about the 2020 Glidewell Symposium.

This issue includes another great contribution from Dr. Randolph Resnik — an in-depth article detailing a simple, clinically proven protocol for the use of blood concentrates for bone regeneration procedures. Don’t forget to go to education.glidewelldental.com and take the short exam to earn CE credit for the article. While you’re on this newly launched website, review the wide array of courses available, each developed with the goal of making it easier for dental professionals to access great clinical training. As always, these online courses are available at no charge.

This spring, Glidewell will present the inaugural Guiding Leaders Summit — a two-day conference designed to empower women in dentistry. Read our interview with Stephenie Goddard, Glidewell executive vice president, to learn more about this unique event taking place in April in Huntington Beach, California. The summit is the culmination of the inaugural group of Guiding Leaders, a leadership development program for women in dentistry. In this issue, Dr. Jill Frazier, a member of the 2019 class, shares her perspective on her experience with the program. Also in this issue, Guiding Leader participant

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We at Chairside magazine will continue our effort to provide you, our readers, with the latest information to further benefit you, your practice, and — above all — your patients. We welcome your feedback and look forward to hearing from you.

With kind regards,

Neil I. Park, DMD Editor-in-Chief chairside@glidewelldental.com

Making the Case for Continuing Education In late 2018, the American Dental Education Association released the results of its annual survey of graduating dental school seniors.1 The graduates’ responses illustrate how they perceive their need for further training in the areas of practice management and clinical dentistry, as well as the importance they place on continuing education.

40.6

Respondents who disagree or strongly disagree with this sentiment: “I am prepared to manage a successful business; I can manage finances, enact a business plan, ensure efficient scheduling and billing, obtain appropriate credentialing, etc.”

65.4%

Respondents who perceive their education and training in “surgical placement of implant” as “inadequate.” In the category “restoration of implant,” 35.5% answered the same way.

1. American Dental Education Association [internet]. Washington, D.C.: American Dental Education Association; c2019. ADEA Survey of Dental School Seniors, 2018 Graduating Class Tables Report. 2018 Nov [cited 2019 Dec 3]. Available from: http://www.adea.org/ADEA_Survey_of_Dental_School_ Seniors_2018_Tables_Report.pdf.

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BY THE NUMBERS

42.1%

‘Moderately Confident’

Respondents who reported feeling only somewhat confident or not at all confident with their skills and abilities in malocclusion and space management.

96.8

Most common response to question regarding respondents’ confidence in their cosmetic and esthetic dentistry skills.

Respondents who agree or strongly agree that “continuing education requirements are necessary for practitioners.”

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Letter to the Editor We encourage your feedback and look forward to answering your questions about our articles.

Dear Chairside® Magazine, In one of your recent issues (Vol. 14, Issue 1), you featured a statistics column entitled “Women in Dentistry.” This article quoted statistics regarding the historical milestones and shifting demographics occurring between male and female dentists in the United States. Dr. Harriet Seldin, who graduated from dental school in 1978, is quoted as saying that 15.9% of first-year dental students were women at that time. I further understand that in 1968 — just a decade before Dr. Seldin graduated — only 1.1% of dental students were female. By 2014, I see this jumps to 47%. A Google search also confirms that 60% of dentists in Europe are female. I have no argument with the statistic showing that 29.5% of U.S. dentists presently are female — but I

question the accuracy of the statement that 2020 is the “projected year in which more women than men will be practicing dentistry in the U.S.” I’m struggling to quantify these numbers. Simple logic would reveal that if the percentage of women graduating from dental school is now about 50%, all men older than these current graduates will need to have either retired or died before the percentage of women practicing dentistry in the U.S. can reach 50%. I look forward to your thoughts on this. Sincerely, William R. Jungman, DDS Escondido, California

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Dear Dr. Jungman, Thank you for taking the time to share your thoughts regarding our recent By the Numbers feature entitled “Women in Dentistry,” specifically the statistic stating that 2020 is the “projected year in which more women than men will be practicing dentistry in the U.S.”

CONNECT WITH CHAIRSIDE Follow us on Facebook, Instagram, Twitter and YouTube @glidewelldental

We agree with you that it will likely take many years beyond 2020 for female dentists to outnumber their male counterparts. Our statement came from a 2013 Inside Dental Technology article written by the late Dr. Connie Drisko. Although women currently outnumber men in dental schools, Dr. Drisko was a bit optimistic in her prediction. We appreciate you taking the time to bring this to our attention, as our objective will always be to provide our readers with clear, factual information. We hope you will continue to enjoy Chairside magazine and will find it to be both helpful and an interesting read.

Access free CE at education.glidewelldental.com Share Your Thoughts If you have any questions, comments or suggestions, email us at chairside@glidewelldental.com or write to: Glidewell ATTN: Chairside magazine 2201 Dupont Dr., Ste. 600 Irvine, CA 92612

Sincerely, CM

SOURCES Drisko C. Gender Shift: The rising female demographic will change the face of dentistry. Inside Dental Technology [internet]. 2013 Dec [cited 2019 Dec 26]. Available from: https://www.aegisdentalnetwork.com/idt/2013/12/ trends-in-dentistry. Needham S. The shifting paradigm of dentistry: The predominance of women. Dental Economics [internet]. 2017 May 1 [cited 2018 April 13]. Available from: https://www.dentaleconomics.com/articles/print/volume-107/issue-5/ macroeconomics/the-shifting-paradigm-of-dentistry-the-predominance-of-women.html.

Please include your full name, address and daytime phone number. All correspondence may be published in an upcoming issue or on our website and edited for clarity and length. Access Our Resources Clinical videos, product information and patient resources are a click away at glidewelldental.com. Advertise or Submit an Article Call 888-303-4221

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KYLE CURRAN

KEN BERLEY, DDS, J.D. Dr. Ken Berley is a dentist and attorney with a practice focused on the treatment of sleep-disordered breathing and TMD. He is a Diplomate of the American Board of Dental Sleep Medicine, a lecturer, and a consultant in the areas of risk management and the development of a successful dental sleep medicine (DSM) practice. Dr. Berley has written numerous consent forms that are used in general and DSM practices. In addition, he is the president of the Dental Sleep Apnea Team, which provides educational opportunities for doctors and dental staff, and he is the coauthor of “The Clinician’s Handbook for Dental Sleep Medicine.”

STUART E. COE, DDS Dr. Stuart Coe owns a private practice in Roswell, Georgia, focused on family, cosmetic and implant dentistry. He earned his DDS degree from the University of Missouri-Kansas City School of Dentistry. Dr. Coe is a member of the Academy of Osseointegration, American Academy of Facial Esthetics, American Dental Association, and Seattle Study Club of Atlanta. In addition, he established and maintains a dental clinic in Eswatini, Africa, through an organization named Heart for Africa, and he travels there yearly.

Kyle Curran is the senior account manager at Pristine Medical Billing, where he helps dental practices navigate insurance claims. He has managed the billing aspect of treatment for more than 50 practices, assisting many dentists who are new to dental sleep medicine. Kyle is also working toward a bachelor’s degree in business administration at California State University San Marcos, and will graduate in the spring of 2020.

RANDY CURRAN Randy Curran is the founder and CEO of Pristine Medical Billing, which serves more than 600 dental practices in 47 states, with an emphasis on dental sleep medicine. Over the past 12 years, Randy has dedicated his life to helping those with sleep-related breathing disorders obtain prior authorizations for coverage while ensuring providers receive fair compensation for care. He has been involved in the treatment of more than 38,000 patients, while collecting over $85 million for providers from insurance carriers through both contracting and claim submissions.

JILL FRAZIER, DDS Dr. Jill Frazier provides a full scope of general and cosmetic dentistry services at Missoula Dental Arts, where she creates beautiful smiles for people throughout the community. Dr. Frazier’s expertise ranges from porcelain veneers, to dental implants, to crowns & bridges.

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TIMOTHY F. KOSINSKI, DDS, MAGD Dr. Timothy Kosinski graduated from the University of Detroit Mercy School of Dentistry and received a Master of Science degree in biochemistry from Wayne State University School of Medicine. In addition to serving on the editorial review board of numerous dental journals, Dr. Kosinski has published over 180 articles and contributed to textbooks on the surgical and prosthetic phases of implant dentistry.

SUSAN MCMAHON, DMD Author, lecturer and instructor Dr. Susan McMahon is an expert in the fields of cosmetic dentistry, dental care and teeth whitening. She is accredited by the American Academy of Cosmetic Dentistry, and has received Top Dentist awards from Pittsburgh Magazine and the Consumers Research Council of America.

RANDOLPH R. RESNIK, DMD, MDS Dr. Randolph Resnik graduated from the University of Pittsburgh School of Dental Medicine and has earned specialty certificates in prosthodontics and oral implantology, as well as a Master of Dental Science. He was chief of staff and surgical director of the Misch International Implant Institute for over 15 years, and is currently the institute’s director and primary lecturer. Dr. Resnik lectures in the U.S. and internationally, and has a practice in Pittsburgh focused on oral implantology.

CONTRIBUTORS CARRIE WEBBER

JESSE TENG, DDS Dr. Jesse Teng is an El Paso, Texas-based orthodontist who specializes in sleeprelated breathing disorders (SRBDs) and childhood airway therapy. He received his Bachelor of Science degree in biomedical engineering from John Hopkins University, then earned his doctor of dental surgery degree from the Columbia University College of Dental Medicine as well as a certificate in orthodontics and dentofacial orthopedics from the University of Rochester Eastman Institute for Oral Health. Dr. Teng is a Diplomate of the American Board of Orthodontics, past president of the Texas Association of Orthodontists, and delegate member of the American Association of Orthodontists. He was recently appointed by Texas Gov. Greg Abbott to the Dental Review Committee of the Texas State Board of Dental Examiners.

Carrie Webber is chief communications officer and co-owner of Jameson Management, Inc., a dental management, marketing and hygiene coaching firm. Carrie creates customer service and business development opportunities as well as marketing initiatives and social media strategies to effectively communicate the Jameson message to the dental profession. She contributes to several publications and is a frequent speaker at dental meetings nationwide.

SERGEI AZERNIKOV, Ph.D. Dr. Sergei Azernikov received his doctoral degree in engineering from the Technion â&#x20AC;&#x201C; Israel Institute of Technology. After spending a year as a visiting scholar at the University of Michigan, Dr. Azernikov joined Siemens Corporate Research in Princeton, New Jersey, where he developed patient-specific medical devices, such as hearing aids and orthopedic implants. Dr. Azernikov joined Glidewell in 2012 to work on dental CAD software automation and currently leads the machine-learning team, which develops AI technologies that will shape the dental industry of tomorrow.

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JUSTIN CHI, DDS, CDT Dr. Justin Chi is director of clinical technologies at Glidewell. He joined Glidewell as a clinical research associate in 2015 after graduating from the Herman Ostrow School of Dentistry of USC. Dr. Chiâ&#x20AC;&#x2122;s previous education included receiving his Bachelor of Science degree in dental laboratory technology from the LSU School of Dentistry, and earning his CDT in crown & bridge in 2007.

NEIL PARK, DMD Dr. Neil Park is vice president of clinical affairs for Glidewell. He received his DMD from Temple University School of Dentistry and practiced general dentistry in Florida before moving on to an accomplished career in the dental implant field, developing continuing education programs and implementing a predoctoral implant curriculum in universities throughout North America. In January 2016, Dr. Park joined Glidewell, where he oversees clinical research as well as training and education programs for implant and restorative solutions.

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Smiling from the Inside Out: Restoring a Smile After an Eating Disorder by Susan McMahon, DMD chairside@glidewelldental.com

reating patients with teeth ravaged by the effects of eating disorders requires a level of care and consultation beyond what is necessary for almost any other presenting dental scenario. It would clearly be counterproductive to restore the smile of someone still struggling with bulimia because the continued purging would destroy new restorations as completely as it did the patientâ&#x20AC;&#x2122;s natural teeth. But how can dentists be certain their patientâ&#x20AC;&#x2122;s struggles with purging are no longer present? How

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can we address the shame and secrecy that so commonly accompany these patients? I was fortunate with Peggy. It was clear from our first consultation that she had freed herself from the grasp of anorexia and bulimia, and was well on her way to achieving optimal health. She spoke with focused intention about being ready to have her teeth fixed and “feel whole again.” This is not common. More typically, such consultations require careful questioning, asking if perhaps the client is experiencing

digestive problems like acid reflux or GERD, and even those questions often can’t compete with the shame-driven evasiveness of a patient with an eating disorder. Peggy’s teeth told a devastating story. Repeated exposure to highly corrosive stomach acids had almost completely stripped the palatal side of her upper teeth of their enamel and shortened their length. After some consultation, we decided together that a full-arch reconstruction of her maxillary teeth was the best option.

Figure 2: As is evident in this view of her upper arch, the repeated purging of stomach contents had stripped away enamel from the palatal of Peggy’s teeth. Further decay around existing fillings was visible as well.

Figures 1a, 1b: Peggy presented with teeth badly misshapen and damaged by the effects of bulimia.

Figure 3: Effectively restoring Peggy’s smile required elongating her teeth. Here you can see the patient’s preoperative teeth through the prep guide and the length to which I elected to extend them.

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Figures 4a, 4b: Peggy’s teeth were prepared for full-coverage BruxZir® Esthetic Solid Zirconia restorations. Note the rounded preps and chamfer margins. The prep shade was recorded, and the horizontal and midline records were taken for the lab.

Figures 5a–5c: Peggy’s temporaries gave us a glimpse of just how astonishing her restored smile would be. She and I evaluated the look and function of her temporaries, and the provisionals were then used as a prototype for the restorations fabricated by Glidewell.

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Figures 6a, 6b: The CAD image of the patient’s final restorations, and the finished BruxZir Esthetic crowns.

Peggy’s presenting smile was the manifestation of the pain and trauma created by her eating disorder. Today she smiles often and freely, secure in the knowledge that her disorder no longer haunts her and that her new look is indicative of the joy she feels each day. CM

Figures 7a–7c: Before and after images illustrate how remarkably the BruxZir Esthetic crowns renewed Peggy’s smile, elevating it to match the new quality of life she now enjoys with her bulimia behind her.

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The Glidewell Dental Symposium was a tremendous success due, in part, to the educators who shared best practices with attendees. Presenters shown left to right: Dr. Raymond Choi; Will Schmidt, RDA; Dr. David Hochberg; Dr. Charles Schlesinger; Dr. Susan McMahon; Dr. Timothy Kosinski; Dr. Steven Barrett; Dr. Neil Park; Jim Glidewell, CDT; Dr. Jack Hahn; Carrie Webber; Dr. Justin Chi; Dr. Taylor Manalili; Dr. Anamaria Muresan; Dr. Suzanne Haley; Dr. Chad Duplantis; Dr. Perry Jones; Dr. Paresh Patel; Dr. Randolph Resnik; and Mark Romano.

Third Annual Glidewell Dental Symposium: A Weekend of Clinical Education

ver 1,000 dental professionals attended the Glidewell Dental Symposium, which took place on Nov. 8â&#x20AC;&#x201C;9, 2019, in Orlando, Florida. The event brought together 21 world-class speakers and included the latest techniques, tools and technologies aimed at making general dentists more successful in their daily practices. The schedule featured 14 fast-paced main podium presentations on the first day and 38 lectures and hands-on workshops on the second day. Sessions covered a wide range of topics, including digital dentistry, esthetics, snoring and sleep apnea, implant dentistry, and prosthetics. During both days, attendees learned about the emerging science, technology and clinical methodologies that are redefining the field of dentistry.

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Kicking off the first day of the symposium, President and CEO Jim Glidewell, CDT, delivered a presentation on some of Glidewell’s groundbreaking technology that is advancing the field of dentistry.

“The symposium was established three years ago to provide clinicians a fast-paced, concise and simplified approach for learning new tools and techniques to expand their service offerings, overcome challenges and meet the needs of patients,” said Dr. Neil Park, scientific chair of the Glidewell Symposium and vice president of clinical affairs at Glidewell. “Judging by the packed course classrooms, and the energy, enthusiasm and favorable responses from attendees, I believe we have accomplished that.” Glidewell faculty and staff are already working hard to bring dentists an even bigger and better weekend of education in 2020. The fourth annual Glidewell Symposium will take place Nov. 6–7 at the Anaheim Convention Center in Anaheim, California, and will feature keynote speaker Dr. Gordon Christensen, a distinguished prosthodontist and cofounder of the Gordon J. Christensen Clinicians Report®. The symposium will once again provide a unique two-day educational format that has proven to be very popular. To learn more and to receive special early-bird pricing information, visit glidewellsymposium.com.

On Day One, attendees participated in a full program of fast-paced presentations. Using the concise style of TED Talks®, these inspiring, powerful and practical presentations covered nearly all aspects of dentistry, ranging from digital dentistry, esthetics and practice management, to atraumatic extraction, implant placement and prosthetics.

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Courses were taught by renowned educators, practicing clinicians and thought leaders. The keynote address, â&#x20AC;&#x153;The Emergency Implant,â&#x20AC;? was delivered by legendary implant-dentistry pioneer Dr. Jack Hahn (pictured), who has been placing and restoring implants for nearly five decades.

As a complement to the impactful CE program, the symposium featured an expansive exhibit area where attendees explored some of the latest dental innovations to enhance patient care.

Attendees participated in fun, interactive exhibits involving artificial intelligence challenges, futuristic robotics, virtual reality tours and other live demonstrations. Here, Dr. Stacy Spizuoco virtually explores the Glidewell campus and its cutting-edge R&D and manufacturing facilities.

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The digital workflow was a main attraction of the exhibit area. Participants learned how to seamlessly integrate intraoral scanning, designing and milling into their own dental practices using the glidewell.io™ In-Office Solution.

Clinicians compared the features and benefits of a wide range of restorative materials available from the laboratory or for use in-office for same-visit dentistry. The advent of the BruxZir® NOW fully sintered in-office milling block (no oven needed) has helped dentists reduce chair time and become more efficient.

At the booths, attendees found many solutions for maximizing their clinical success. Some of the must-see products included the Hahn™ Tapered Implant System, Inclusive® Mini Implants and the new 12-piece Newport Surgical™ Implant and Bone Grafting Instrument Kit, which was developed to streamline surgical cases.

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At the exhibit for dental sleep medicine, one of the fastest growing areas of dentistry, attendees asked questions about the differences between the Silent Nite® Sleep Appliance and OASYS Hinge Appliance™, two popular devices for treating snoring and sleep apnea.

A group of attendees stepped up to this 360-degree booth, where their cell phones rotated around to create a slow-motion video. It provided a memorable souvenir and a great way to wind down after a full day of education.

Mentors and colleagues met for many networking opportunities during the event. For example, Stephenie Goddard (fourth from left), executive vice president at Glidewell, was with Guiding Leaders Drs. Lan Chi Le, Susan McMahon, Stacy Spizuoco and Taylor Manalili. Guiding Leaders, a leadership development program for women in dentistry, will host its inaugural two-day CE summit in Huntington Beach, California, on April 24–25, 2020.

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On the second day of the symposium, attendees had the opportunity to choose from 38 lectures and hands-on workshops focusing on in-depth instruction. For example, in Dr. Timothy Kosinski’s hands-on program “Immediate Implant Placement After Extraction” (pictured), doctors practiced implant placement in an extraction site using a specially designed model.

In Dr. Randolph Resnik’s breakout course “Atraumatic Extraction and Socket Grafting,” participants learned important protocols for atraumatic extractions, as well as effective techniques to preserve bone in preparation for future dental implants.

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Dr. Paresh Patel explained the clinical considerations, treatment protocols and advantages of full-arch implant solutions, from overdentures to monolithic zirconia fixed implant prostheses, in the hands-on program “Full-Arch Implant Restorations.”

During the course “Patient Communication for Practice Growth,” instructor Carrie Webber discussed why patients may not follow through with a treatment plan, as well as the solutions for overcoming roadblocks to case acceptance.

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In Mark Romano’s lecture “Effective Marketing Strategies for Your Practice,” dentists learned tactics for maximizing their practice profile online and in social media. CM

The next Glidewell Symposium will take place Nov. 6–7, 2020, in Anaheim, California. Visit glidewellsymposium. com for more information.

TED Talks is a registered trademark of Ted Conferences, LLC. OASYS Hinge Appliance is a trademark of Dream Systems LLC.

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WATCH THE VIDEO Catch the Glidewell Dental Symposium highlights at glidewellsymposium.com

Glidewell Dental Symposium 2019: Answers to Audience Questions

he third annual Glidewell Dental Symposium featured two panel discussions during the Friday general session. We were pleased to receive a large number of thoughtful and provocative questions for our speakers â&#x20AC;&#x201D; too many to answer during the panel. In the following pages, we present additional responses to some of the audience questions regarding implant-protected occlusion, bonding techniques, zirconia adjustments, packing cord, guided surgery, and more.

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BONE DENSITY: KEY SUCCESS FACTOR IN IMPLANT DENTISTRY

ENHANCING ESTHETICS WITH PREPARATION DESIGN Anamaria Muresan, DMD, ME, CDT

Randolph R. Resnik, DMD, MDS

What is the bonding protocol for BruxZir® Esthetic veneers, crowns and bridges?

What does implant-protected mean, and why is it used?

DR. MURESAN: BruxZir restorations can be bonded or cemented. When bonding is indicated, the following protocol is recommended: air-abrade, decontaminate and apply MDP primer.

DR. RESNIK: Implant-protected occlusion is an occlusal scheme that reduces the resultant forces at the implant interface in the crestal bone. Proposed by Dr. Carl Misch in 1994, this occlusal concept is based on reducing biological and mechanical complications — such as bone loss, periimplant disease, screw loosening, implant fracture or prosthesis failure — by developing an ideal occlusal scheme. By adhering to these principles, the possibility of occlusal overload is decreased, thereby maintaining implant occlusal load within physiologic limits. The following factors make up the concept of implant-protected occlusion:

1. Abrade: Your restoration will come back from the lab already air-abraded. 2. Decontaminate: After trying in the restoration and making any needed adjustments, decontaminate by using Ivoclean® (Ivoclar Vivadent; Amherst, N.Y.) or sodium hypochlorite. 3. Prime: Prime the BruxZir restoration with a reagent that contains MDP, such as Z-Prime™ Plus (BISCO; Schaumburg, Ill.) or Monobond Plus® (Ivoclar Vivadent). 4. Bond: For the bond itself, you can use your resin cement of choice and bond the restoration in a clean and dry field.

FULL-ARCH IMPLANT RESTORATIONS: TOO COMPLEX FOR GPs?

1. No Premature Occlusal Contacts: Because of the difference between a nonmobile implant and a tooth with a periodontal ligament, occlusal contacts should be timed to prevent premature occlusion. 2. Mutually Protected Occlusion: This occlusal concept is also known as canine guidance, with the anterior teeth protecting the posterior teeth and the posterior teeth protecting the anterior in excursive movements. By adhering to mutually protected occlusion, fewer force-related complications occur. 3. Shallow Anterior Guidance: The anterior guidance should be shallow to decrease force on implants. 4. Minimal Cusp Height: The greater the cusp angle, the greater torque and associated shear forces.

Paresh B. Patel, DDS What is the current recommendation for removing the full-arch zirconia prosthesis on recall appointments? If you do remove it periodically on recall appointments, how often do you replace the old screws with new screws? DR. PATEL: I do not typically remove the BruxZir Full-Arch Implant Prosthesis unless there is evidence of inflammation or if my hygienist confirms she cannot remove debris near the intaglio surface. According to the American College of Prosthodontists article “Clinical Practice Guidelines for Recall and Maintenance of Patients with Tooth-Borne and Implant-Borne Dental Restorations,” published in January 2016, it is not recommended to remove the prosthesis for routine cleanings. If you do remove the prosthesis, it is recommended that you replace the screws with new ones.

occlusion

5. Narrow Occlusal Table: Decrease the occlusal table width to concentrate forces over the implant’s long axis. 6. Ideal Occlusal Contacts: Occlusal contacts should be in the central fossa, and contacts on cantilevers and marginal ridges should be avoided. 7. Minimized Cantilevers: Especially with unfavorable crown-implant ratios and parafunctional habits, cantilevers should be minimized to decrease nonideal forces. 8. Controlled Parafunctional Forces: The use of occlusal guards, such as Comfort H/S™ Bite Splints, should be considered with the treatment plan, especially if parafunctional habits are present. Additional concepts on bone density and implant-protected occlusion can be found in my four-part article series “Principles of Implant Occlusion” at chairsidemagazine.com.

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THE STATE OF THE ART: MONOLITHIC ZIRCONIA

BENEFITS OF GUIDED SURGERY

Justin Chi, DDS, CDT

Charles Schlesinger, DDS

I’ve heard it’s better to adjust adjacent or opposing teeth rather than the zirconia crown. Does adjusting the zirconia compromise the integrity of the restoration? DR. CHI: If done correctly, adjusting the BruxZir restoration won’t compromise the restoration’s integrity. The main concern is not to leave the surface roughened after making adjustments with a diamond bur. I recommend the BruxZir™ Adjustment & Polishing Kit (Glidewell Direct; Irvine, Calif.) to safely and efficiently make corrections. Polishing the adjusted areas will ensure the restoration has a wear rate similar to natural dentition.

Do you recommend taking the surgical guide off after the pilot drill and then taking an Xray to confirm the alignment is correct? DR. SCHLESINGER: I do not recommend that. You should have confidence that the treatment plan you approved and the surgical guide produced from it are correct. The only time you will remove the guide is after the tissue punch and after you have delivered the implant. Trust the technology!

The Hahn™ Tapered Implant Guided Surgery System (Glidewell Direct) allows clinicians to confidently place implants through a digitally fabricated surgical guide with a high degree of precision and predictability. The BruxZir Adjustment & Polishing Kit is a safe and efficient way to modify and polish restorations.

GO ONLINE You can purchase the kit online at glidewelldirect.com

The technology behind guided surgery has helped make implant placement a smooth and safe experience.

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ANTERIOR IMPLANT RESTORATIONS: KEYS TO SUCCESS

PROVISIONAL RESTORATIONS: PLANNING FOR ESTHETIC SUCCESS

Timothy F. Kosinski, DDS, MAGD

Steven Barrett, DDS

Does the Penguin RFA® (Glidewell Direct) measure boney integration or just stability? Are the two the same? DR. KOSINSKI: The Penguin RFA provides an assessment of implant stability by measuring the micromobility of the implant. This is influenced by both the initial (mechanical) stability and the degree of osseointegration. During the healing process, mechanical stability decreases, while the stability from osseointegration increases. So, by comparing the ISQ reading at initial placement with subsequent readings, the clinician can obtain an accurate indication of boney integration. Penguin RFA is a registered trademark of Integration Diagnostics Sweden AB.

Typically, I initially scan the prepared teeth and then have BioTemps® Provisionals (Glidewell) fabricated and seated. After the patient wears these temps for some time and I adjust and contour them for bite and occlusion, do I need to rescan the prepared teeth or just scan the BioTemps Provisionals and send that file? DR. BARRETT: If no further adjustments were done to the teeth after your initial scan, then the lab can use that scan to make the crowns. You will then just take a new scan of the perfected occlusion and contours of the BioTemps Provisionals as a guide for the final restorations.

MILL IT CHAIRSIDE OR SEND IT TO THE LAB? Chad Duplantis, DDS Is packing cord necessary every time you scan a crown preparation?

The Penguin RFA, available for the Hahn implant system via Glidewell Direct, provides an assessment of implant stability by measuring the micromobility of the implant.

DR. DUPLANTIS: Packing cord is part of my routine when scanning a crown preparation. If I cannot see the margin, the intraoral scanner isn’t going to see it either. If I still don’t have clear visualization, I will pack a second cord and use the double-cord technique to ensure the margin is clearly visible. You must treat each case individually and make sure that the margin is visible in its entirety.

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In her presentation “Enhancing Esthetics with Preparation Design,” Dr. Anamaria Muresan described how a minimum-prep design can correct up to three shades.

During his presentation “Anterior Implant Restorations: Keys to Success,” Dr. Timothy Kosinski discussed how placing implants in the anterior area can have challenges with respect to the esthetic expectations of the patient and how case selection and thorough presurgical planning is vital.

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In Dr. Justin Chi’s presentation “The State of the Art: Monolithic Zirconia,” he illustrated why BruxZir Esthetic Solid Zirconia is the first true anterior-grade zirconia ever developed.

In his presentation, Dr. Chad Duplantis described how to choose between in-office milling and lab fabrication, laying out the criteria that should be considered. CM

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MY FIRST IMPLANT

My First ‘Emergency’ Implant with Stuart E. Coe, DDS chairside@glidewelldental.com

r. Stuart Coe began offering implant surgery at his Roswell, Georgia, practice to make treatment available to more of his patients. In this interview, he describes how the unique features of the Hahn™ Tapered Implant System helped him confidently perform his first “emergency” implant case — immediate implant placement and provisionalization at the time of extraction.

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CHAIRSIDE ® MAGAZINE: Can you begin by telling us about yourself and how you got started in dentistry? DR. STUART COE: I’ve been practicing dentistry for 35 years. My interest in dentistry began way back in seventh grade when I wrote a paper about wanting to be a dentist when I grew up. I knew back then the direction I wanted to go, and I have never looked back. I am very blessed to wake up every morning and feel enthusiastic about going to work and treating my patients. CM: How much exposure to implantology did you receive in dental school? SC: Implants were not being taught in dental school when I was a student. Implants had not gone mainstream yet. We were aware of the concept of implants, but no practical instruction was offered. Very early in my practice I did get involved with restoring implants, but I have only been placing implants for about four years now. I wish the simple implant systems of today, such as the Hahn™ Tapered Implant System (Glidewell Direct; Irvine, Calif.), were available 20 years

ago, as it would have been nice to get started earlier in my career. CM: What got you started placing implants? SC: I have been very comfortable performing my own surgeries for a long time: extractions, socket augmentation and flap surgery. So the learning curve for implants really just involved how to place them. Many of my patients have been coming to me for a very long time, so they automatically had a great amount of trust in me. Implants were a treatment option they were asking for, and I wanted to provide it so they could receive care from someone they knew and trusted. My patients also love the fact that they can get the implant and the restoration completed at one office. CM: What kind of education did you invest in, and what courses did you take? SC: I took a relatively simple but effective hands-on course from the American Academy of Facial Esthetics. The course actually featured quite a few of Dr. Timothy Kosinski’s videos. I know he teaches for Glidewell Clinical Education and has done numerous informative articles on implantology for Chairside magazine, so it was great to learn from him. The Hahn implant system was used throughout the course, too. CM: Is that how you got started with Hahn implants?

Dr. Stuart Coe serves many longtime patients who trust him to deliver a broad range of treatment options. Offering implant placement has made treatment possible for more patients in his practice.

SC: Yes, and I’ve been familiar with the Hahn implant ever since the Misch International Implant Institute made it their official implant system. After taking the course and seeing the system in action, I started doing my own research on the implants and comparing them to the other products on the market. But knowing that the

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The Hahn™ Tapered Implant System’s user-friendly surgical protocol has helped Dr. Coe expand the implant services offered by his practice to include a wider range of indications, including extraction with immediate implant placement.

Misch Institute uses Hahn really made the choice a slam dunk for me. CM: We understand that you recently performed your first emergency implant case. Can you share your experience with us? SC: She’d been my patient for 20 years, so we knew each other really well. She presented with a fractured cuspid. The existing crown had broken off at the gumline. We discussed doing crown lengthening, post and core, and a crown. But from my experience, the long-term survival of a post and core and a crown on a cuspid tooth is limited. After explaining the pros and cons of both options, she opted to do an extraction with immediate implant placement and loading, which was my first time doing that. Because this was in the anterior region, my concern was to make sure the interdental papillae were preserved for esthetic purposes. CM: And how did the case go? SC: The extraction went perfectly. We were able to preserve the buccal bone

MY FIRST IMPLANT SC: The Hahn implant established high primary stability, so I felt comfortable immediately loading it. I could have used a healing abutment, but because this was in the anterior region of the mouth I thought we

Figure 1: The patient presented with a fractured existing crown on #11.

should just go with a nice temporary that would mimic the final restoration and preserve the papillae. Plus, as a general practitioner, I am well trained in fabricating high-quality, esthetic provisionals because we do it all the time. This meant that I could provide her with a beautiful temporary restoration. CM: How did you provisionalize the patient? SC: I fabricated a vacuum-formed stent over the original model, and then screwed a Hahn Temporary Abutment into the implant. I cut the abutment down to the correct size in the lab and replaced it on the fixture. I cut a hole in the stent so the abutment screw pin would extend beyond the stent. I then filled IntegrityÂŽ Temporary Crown and Bridge Material (Dentsply Sirona Inc.; York, Pa.) in the incisal Âž of the cuspid tooth in the stent, adding enough material to engage the abutment.

Once the material set, I unscrewed the abutment and pulled it out of the stent. Figure 2: After taking digital radiographs, it was determined that extraction followed by immediate placement of a Hahn Tapered Implant would be the best treatment.

really well, so I felt comfortable going with immediate placement. Using digital radiographs, I determined that I needed to use a 3.5 mm x 13 mm Hahn implant. After placement of the implant, we got excellent initial stability, which is a testament to the aggressive thread design of the Hahn implant. It really just grabs onto the bone, and I was able to torque it down to 50 Ncm. I did place some cortical/ cancellous allograft to fill in any voids around the implant. CM: Why did you choose to immediately load the implant with a provisional crown?

3b 4a

Figures 3aâ&#x20AC;&#x201C;3c: The tooth was extracted, the site was prepared following a simplified drilling sequence, and the implant was placed, establishing the high primary stability needed for immediate loading.

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Figures 4a, 4b: The goal of provisionalization was to preserve the interdent papillae. A vacuum-formed stent was fabricated chairside, and a screw-retained temporary restoration was crafted using composite material.

I then used Flow-It™ ALC™ Flowable Dental Composite (Pentron Clinical Technologies LLC; Wallingford, Conn.) to fill in the rest of the voids. Then I incrementally added more composite to create the gingival marginal area and the appropriate emergence profile. The final result was a nicely contoured provisional that did indeed look very much like the final restoration. I also adjusted the occlusion so that the patient’s bite was not colliding in the case of any excursive movements. CM: How was the healing process?

pill the first evening, and then just ibuprofen after that. We left the beautiful provisional in for about four months while everything healed and integrated. When the patient returned for the final impression, the implant had indeed established excellent integration. I was extremely pleased with the results, and it was solid as a rock. There was no doubt about that. But what I really loved was the appearance of the tissue. The papillae were well developed and ideal in form. All of this made for a perfect final impression to send to Glidewell.

SC: Well, first of all, after the patient left she had very little postoperative pain. She took one prescription pain

CM: How did the patient like the final result?

SC: She was ecstatic about it. Everything looked perfect. Glidewell made a beautiful screw-retained restoration that was seated with very few adjustments. CM: How has your experience been using the Hahn Surgical Kit? SC: It is very orderly and simple. The way they color-code the drills is brilliant. For doctors who are just starting out with implants, you don’t want to be thinking too much about what drill comes next and what sequence to follow. The surgical kit makes it all very straightforward. You really can’t make too many mistakes with the Hahn system. Its simplicity is definitely one of the many strengths of the system. CM: For general dentists interested in placing implants, how would you recommend getting started?

Figures 5a, 5b: The patient’s healing progression was predictable. Figure 5a is day of surgery and Figure 5b is at four months.

Figures 6a, 6b: The gingival architecture was well preserved, and the patient was very pleased with the final screw-retained crown fabricated by Glidewell.

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SC: If the dentist is not presently doing any oral surgery in his or her practice, my first suggestion is to begin doing some surgeries such as simple extractions, laying gingival flaps, and bone augmentation procedures to re-familiarize oneself with basic surgery techniques, just as I did. It is quite a jump to go from doing no oral surgery at all to placing implants. Taking an implant course is essential too, of course. There are a lot of great courses out there, from the Misch Institute to the programs offered through Glidewell Clinical Education, so I recommend that all dentists consider taking that first step. That in turn can lead you down a path that makes a huge difference in the lives of your patients. CM

Make Implants a BIGGER Part of Your Practice I am now able to confidently place most of the requested implants in my practice. — Stephanie Tilley, DMD General Dentist — Pensacola, Florida

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My First 60 Days: A glidewell.io™ Practice Report Interview with Michael D. Buck, DDS chairside@glidewelldental.com

hen a practice decides to invest in the glidewell.io™ In-Office Solution, the process of delivering same-visit crowns starts immediately. A team of skilled Glidewell technicians arrives on-site and spends the day with the doctors and team, setting up the system and providing thorough training. Typically, new glidewell.io users produce an average of 25 in-office crowns within their first 60 days of ownership. And then there’s Dr. Michael Buck of Creston, Iowa, who took things to a whole new level. Dr. Buck and his team at Buck Family Dentistry recently broke the curve among new users with an impressive count of 56 same-visit restorations successfully designed, milled and delivered within two months of their glidewell.io purchase. With that information in mind, we knew it was time to sit down with Dr. Buck and learn more about exactly how those record-setting first 60 days unfolded.

Dr. Buck and his team at Buck Family Dentistry recently broke the curve among new users with an impressive count of 56 same-visit restorations successfully designed, milled and delivered within two months of their glidewell.io purchase.

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CHAIRSIDE® MAGAZINE: Dr. Buck, please tell us a bit about yourself and your background, as well as the background of Buck Family Dentistry. DR. MICHAEL BUCK: I grew up right here in Creston, Iowa, where my father is also a dentist and has had a practice for many years. I went to the University of Iowa for my undergraduate degree and dental school. In 2013 I purchased a practice back here in Creston, and one year later my father and I combined our practices to open Buck Family Dentistry. We’ve been practicing together here in Creston ever since, providing general dentistry to patients of all ages.

Dr. Michael Buck (right) and his father, Dr. Dave Buck (left), own and operate Buck Family Dentistry in Creston, Iowa. The doctors and staff at the practice have adapted quickly and successfully to the glidewell.io In-Office Solution, producing nearly twice as many crowns as average in their first two months with the system.

CM: Where do your patients tend to come from? I know Creston is a fairly small town. MB: Creston itself is probably around 8,000 people, but we keep very busy because we serve the surrounding communities as well. I would say we draw patients from as far as 30 miles away. CM: What led you to the decision to invest in glidewell.io? MB: I’d been a customer of Glidewell since 2013, and they have always given me great service. The services they provided were always extremely high-quality. Then, sometime late last year, I received correspondence from the glidewell.io team introducing the system, and I was interested. At one point Dr. Justin Chi at Glidewell used glidewell.io to create a crown for one of my patients and sent it to me. Seeing the great results for myself, along with the positive relationship I already had with the lab, convinced me that I was ready to go. CM: Had your patients been requesting same-visit crowns? MB: I’ve always paid attention to

Dr. Buck’s decision to add glidewell.io and same-visit crowns to the services offered by Buck Family Dentistry was driven by his awareness of how quickly digital dentistry is growing, and by his end goal of providing the best in care to patients in the most convenient way possible.

what’s newest in digital dentistry, and I’ve known for a while that it’s just getting better and better. Very soon, if not already, patients will be seeking out same-visit restorations and expecting it from their doctors. So honestly, I made the investment as a benefit to our patients more than anything. We always want to be capable of giving them the best quality care in a way that works best for them. CM: That’s becoming a fairly common reason why doctors are looking to glidewell.io: They’re real-

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izing that digital technology is here to stay, and patients will soon be expecting same-visit crowns. MB: Exactly. You get that feeling of, “I’d better keep up or I might be left behind.” CM: Let’s discuss those first 60 days you had with glidewell.io officially installed in your practice. I know the implementation team was there on-site on the first day to perform the installation and train your team. How did that day go for all of you?

errors. At one point, for example, I put the wrong milling block in the mill. The bur didn’t like that, so it threw an error message at me. But that was the only unexpected moment we’ve had, and that was solved with one quick phone call to the glidewell.io support team. CM: It sounds like you were off and running pretty quickly toward that “56 in 60 days” achievement.

Dr. Buck was familiar with the process of digital scanning and the use of the iTero Element ® intraoral scanner, but the rest of the technology behind glidewell.io was new to him and his staff. This didn’t dim his enthusiasm for the capabilities of the technology and the possibilities it opened up for patient treatment.

MB: I thought it was very streamlined, efficient and hugely beneficial for us. The in-person support and training, and the help from the implementation team in general, was fantastic. They were very good. Most of it was entirely new to the staff, but I’d been on the glidewell.io website beforehand watching all of Dr. Chi’s videos on how he uses the system, so I felt well prepared myself. But the Glidewell team did such a great job while they were here that the team was really surprised and happy with how userfriendly glidewell.io ended up being for them. CM: Did you have previous experience with digital technology, like an intraoral scanner? MB: Yes, we did have an iTero Element scanner for about a year before we bought glidewell.io. So all of us were used to scanning patients and creating digital impressions. But none

of us had ever worked with in-office designing or milling. CM: When the setup and training were over and the implementation team left, did you all feel ready to go it alone? MB: You know, I think there are always butterflies or anxiety with something this new, and there’s always that moment when you have the first patient in the chair and you’re thinking: “Is this going to work? Will we be able to do this?” But I felt pretty confident we knew what we needed to know. I was definitely confident in the technology and its capabilities, and everyone else latched onto my confidence quickly. CM: No unexpected mishaps or anything, then? MB: Not yet! Honestly, we haven’t had to call in for support other than one or two bumps we had that were just user

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MB: I was definitely onboard immediately, and so was my father, Dr. Dave Buck. The main thing was that I really wanted to get the most out of the technology, so right off the bat I was ready to get going. And the end result of the enthusiasm and the great training was that all of us ended up jumping in with both feet. We were successfully doing onlays and crowns right away. CM: You mentioned that you were already using digital scanning in the practice, but that the rest of this technology was a whole new addition to your workflow. Tell us a little about how this addition changed the shape of the workday for you and the team. MB: The question on everyone’s minds was how same-visit dentistry would actually work for us in real life, and what that would look like. Everyone, from the front desk to the assistants, had some anxieties about how our workday would change, but we adapted really well as soon as we saw how simple the process itself was going to be. CM: Did anything surprise you during those first 60 days by being easier, or more challenging, than you’d expected? MB: I was very pleasantly surprised at how easy the design process with the fastdesign.io™ Software actually is. You just mark your margins and then

click to generate the design proposal. The designs that come back from the software are very precise and don’t need much, if any, adjustment, other than a couple of times when maybe we decide to tweak the contacts. But that whole process takes just a couple of minutes, and then it’s a just a matter of pushing one more button to review and send the design to the mill. It’s all very straightforward and fast. CM: Straightforward and fast is definitely the ideal goal. MB: Absolutely. One bit of information that stuck with me, which I heard both in Dr. Chi’s videos on the website and from the implementation team, was that if you are spending more than five minutes making tweaks to that auto-generated proposal, then you’re probably making it too complicated. I’ve used that as my guide for the designing process, and it’s absolutely true. CM: Dr. Buck, considering your success in adopting and adapting to glidewell.io, what advice would you offer to doctors who are considering the system, but are concerned about the timeframe for training or the workflow changes required for implementation?

Despite initial anxieties about the learning curve, the team at Buck Family Dentistry quickly became proficient users of glidewell.io. Between the on-site training provided by Glidewell and the enthusiasm of Dr. Michael Buck (right), they found themselves setting a record for crown production in the first two months of use.

The assistants at Buck Family Dentistry have quickly become adept with glidewell.io and are continuously working to maximize the efficiency of their workflow.

MB: I would encourage them and let them know that, yes, integrating the system into your practice does have a learning curve. Most new things do. However, once you get going, you realize pretty quickly that the curve isn’t as steep as you’d thought. I’d highly encourage anyone considering purchasing glidewell.io to do so. CM: Thank you so much for your time, and congratulations on your achievements with glidewell.io. MB: We consider glidewell.io to be a huge success in our office. Thank you so much. CM

The process of designing crowns with fastdesign.io was pleasantly simple and streamlined for Dr. Buck. He stands by something he learned from the Glidewell team during the training process: If he finds himself spending more than five minutes adjusting an automated design proposal, he’s overthinking it.

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Implant Surgery: When Should You Use a Flapless Technique? by Timothy F. Kosinski, DDS, MAGD chairside@glidewelldental.com

mplant placement is becoming increasingly routine in the general practice, but with it comes a range of decisions that must be made as we evaluate the patient in advance of surgical intervention. When treatment planning a case, we must assess the available bone and quality of the soft tissue, and plan a restorative-driven surgical procedure. A key consideration involves determining which surgical technique to use to access the implant site.

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After gaining a clear understanding of the available hard and soft tissue through intraoral evaluation, radiography and — when possible — CBCT scanning, the clinician can determine whether flap reflection or a flapless surgical procedure is ideal for the individual patient. Both of these surgical techniques offer advantages, and the approach should be determined based on the amount of attached tissue present at the implant site, as well as the volume of bone. When the attached tissue is minimal, a flap procedure allows the surgeon to reposition the flap to create more attached gingiva and improve the interdental papillae at the implant site. Reflecting a gingival flap also enables the practitioner to more clearly see the final position of the implant at the crest of the bone. If it’s necessary to visualize the bone during the surgical procedure due to uncertain ridge width or height, flap reflection is the safest, most predictable approach. In contrast, with a flapless procedure, a tissue punch is used to gain access to the bone through the gingiva, minimizing postoperative discomfort by eliminating incisions in the mucosal tissue. Whenever mucosal tissue is incised, prostaglandin and histamine are released, resulting in potential postoperative swelling and pain. Therefore, when there is an adequate width of attached gingiva on the facial aspect of an implant site, a flapless procedure may be indicated, eliminating any suturing requirements.

CASE REPORT The following case, which I performed alongside Dr. Stephanie Tilley of Pensacola, Florida, illustrates the use of both surgical techniques for the same patient, who presented with edentulous spaces in the areas of both right and left maxillary first bicuspids. Due to varying soft-tissue volume on each side of the arch, implant surgery was performed using a flapless procedure for one site, while the attached gingiva was reflected to expose the available hard tissue for the other. As a result of proper site evaluation, treatment planning and restorative-driven implant placement, both surgical techniques led to successful outcomes for the patient.

(1a) Flapless Procedure

Advantages of Flap Procedure • Flap can be repositioned to create more attached gingiva • Visualization of, and access to, the underlying bone • The final positioning of the implant platform can be observed

Advantages of Flapless Procedure • Simple, efficient access to the implant site

(1b) Reflection Procedure

Figures 1a, 1b: The patient presented with two missing maxillary first bicuspids and expressed interest in implant treatment. After careful evaluation of the hard and soft tissue, we decided to place two Hahn™ Tapered Implants (Glidewell Direct; Irvine, Calif.). In the area of tooth #5, where ample attached gingiva was present, we opted for a flapless surgical procedure (1a). For tooth #12, where less attached gingiva was present, we chose to reflect the soft tissue to expose the available bone (1b).

• Postoperative swelling and discomfort are minimized • No suturing required

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(2a) Flapless Procedure

(2b) Reflection Procedure

(4a) Flapless Procedure

Figures 2a, 2b: Although CBCT analysis allows the practitioner to evaluate the edentulous sites in three dimensions, the ability to determine proper implant placement using digital two-dimensional radiography is helpful. A 5 mm ball bearing was placed over each edentulous area with orthodontic wax, and digital radiographs were made. This allowed a precise assessment of the available vertical bone, using the apices of the adjacent teeth as a safeguard for depth of the final implant. Mesialdistal distance between the adjacent teeth was also determined using this method, aiding the selection of implant diameter for each site.

(4b) Reflection Procedure

Figures 4a, 4b: The amount of available attached gingiva was verified during infiltration of local anesthesia, and the mucogingival line was assessed. A 2 mm band of attached gingiva is required on the facial aspect of each implant to ensure peri-implant health. When reflecting the facial tissue for the maxillary left bicuspid, an Orban knife was used to incise on the buccal aspect of the crest with great control (4b).

(3a) Flapless Procedure

(3b) Reflection Procedure

Figures 3a, 3b: CBCT analysis is a tool that allows the dentist to precisely visualize vital anatomy and bone contours as well as virtually place the implants in the edentulous sites.

Figure 5: For the implant site in the area of tooth #12, an envelope flap was reflected with no vertical releasing incision into the mucosal tissue. The incision was made on the edentulous crest around the adjacent teeth, providing control of the flap while minimizing postoperative discomfort.

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(8a) Flapless Procedure 6a

(8b) Reflection Procedure

Figures 6a, 6b: A tissue punch was used to provide access to the maxillary right bicuspid site, facilitating the flapless procedure.

Figures 8a, 8b: Each osteotomy was widened using a straightforward series of shaping drills. These burs are marked to individual depths, which are readily evaluated radiographically. Finally, the osteotomies were widened using the final drill for the 3.5-mm-diameter Hahn implants selected for each site.

(9a) Flapless Procedure (7a) Flapless Procedure

(9b) Reflection Procedure

(7b) Reflection Procedure

Figures 7a, 7b: The Hahn surgical kit contains a 2.4-mm-diameter pilot drill, which is used to establish proper depth and angulation of the implant osteotomy. Radiography was used to confirm proper positioning of the drills prior to continuing with the surgical procedure. The remaining drills in the sequence are length-specific, facilitating proper positioning of the osteotomy.

Figures 9a, 9b: The 3.5 mm Hahn implants were threaded into position. The tapered bodies of the implants feature prominent threads, which eased placement into the osteotomy sites and helped maximize initial stability. The implants were first inserted to the height of the soft tissue and then torqued to final position using a torque wrench. The advantage of flapped surgical placement is that the practitioner can clearly see the final position of the implant at the crest of the bone. When doing a flapless procedure, one must use radiographs to determine ideal crestal seating of the implant.

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(10a) Flapless Procedure

(12a) Flapless Procedure

(12b) Reflection Procedure

Figures 12a, 12b: Screw-retained crowns were designed and milled with CAD/CAM technology and conformed to the soft-tissue anatomy of the implant sites upon delivery.. The screw-access channels were sealed with composite.

(10b) Reflection Procedure

(10c) Reflection Procedure

Figures 10aâ&#x20AC;&#x201C;10c: High primary stability was achieved with the Hahn implants, so 3-mm-tall healing abutments were connected. This eliminates the need for second-stage surgery prior to final impressions of the implant sites. Note the minimal surgical trauma on the right side of the arch (10a) due to the flapless surgical technique, whereas in the case of flap reflection, suturing is required to achieve closure of the implant site (10b, 10c).

(13a) Flapless Procedure

(13b) Reflection Procedure

Figure 11: After four months, favorable tissue health was observed at both implant sites. Hahn scanning abutments were connected to the implants, and digital impressions were taken and sent to the lab for the fabrication of BruxZirÂŽ Full-Strength Solid Zirconia screw-retained crowns.

Figures 13a, 13b: The final delivery was a smooth and efficient process for each implant site, with excellent tissue health in the area of both restorations. The surgical procedure selected for each site facilitated a predictable outcome and an excellent long-term prognosis. CM

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Why Every Dentist Must Screen for Sleep-Related Breathing Disorders by K en Berley, DDS, J.D., and Jesse Teng, DDS chairside@glidewelldental.com

This is the first in a series of articles that will focus on the screening and treatment of patients with sleep-related breathing disorders (SRBDs). This article will outline why all dentists must screen their patients for SRBDs as well as potential legal implications.

n October 2017, the ADA adopted a resolution titled “The Role of Dentistry in the Treatment of Sleep Related Breathing Disorders.” This resolution states, in part, that “dentists are encouraged to screen patients for SRBD as part of a comprehensive medical and dental history … If risk for SRBD is determined, these patients should be referred, as needed, to the appropriate physicians for proper diagnosis.”1 The ADA policy statement additionally recognizes the growing prevalence of sleep disorders found in pediatric dental patients: “In children, screening through history and clinical examination may identify signs and symptoms of deficient growth and development, or other risk factors that may lead to airway issues. If risk for SRBD is determined, intervention through medical/dental referral or … treatment may be appropriate to help treat the SRBD and/or develop an optimal physiologic airway and breathing pattern.”1

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The previous statement clearly places all dentists on legal notice that a reasonable and prudent practitioner would screen all patients for SRBDs. This is particularly true for patients presenting with a high probability of SRBDs.2 SRBD is an umbrella term used to describe several chronic sleep-related conditions in which there is a partial or complete blockage of airflow during sleep. Unfortunately, these events can occur many times throughout the night.3 The tongue, tonsils, uvula and soft palate may act in concert to restrict or completely block a patient’s airway during sleep. These airway restrictions are a direct result of anatomical characteristics, negative inspiratory pressure and gravity. A partial airway blockage can present as snoring. In more serious cases, the patient’s airway can be completely blocked for more than a minute.4 Numerous studies have demonstrated that sleep-disordered breathing is both a prevalent phenomenon and associated with serious health consequences.5,6 When patients have an SRBD, their sleep is interrupted by repetitive events in which their breathing stops and starts. These airway events frequently result in daytime sleepiness or fatigue, which may interfere with a patient’s ability to function and reduces the patient’s quality of life.7 Symptoms may include snoring, pauses in breathing described by bed partners, and disturbed sleep. Obstructive sleep apnea (OSA), which is by far the most common form of sleep-disordered breathing, is associated with many other adverse health consequences, including an increased risk of death.8 Untreated sleep apnea has been directly linked to hypertension, strokes, heart attacks, Type 2 diabetes, cancer, dementia, industrial and automobile accidents, and even sexual dysfunction. Research has also shown that older adults with excessive daytime

Dental practitioners should routinely screen all patients for SRBDs and provide immediate care for patients with significant SRBD symptoms.

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sleepiness and moderate to severe sleep apnea are more than twice as likely to die as those who donâ&#x20AC;&#x2122;t have it.8 While SRBDs are considered medical conditions, they fall squarely within the definition of the practice of dentistry. Therefore, from a legal perspective, with the adoption of the ADA protocol on SRBDs, every dentist must become very familiar with this condition and incorporate a screening protocol into their examination routine. Unfortunately, failure to screen a patient for SRBDs can expose dentists to legal risks similar to those that result from a failure to screen for oral cancer. In 2010, the ADA issued a policy statement on the evaluation of all patients for oral cancer. Now, a decade after the adoption of this statement on screening for oral lesions, lawsuits for failing to screen for oral cancer are a common occurrence. Fortunately, as of the writing of this article, no lawsuits have been initiated based on any dentist failing to screen for SRBDs. However, as more attorneys become familiar with the ADA screening protocol for SRBDs, lawsuits are likely to appear in the future. It is fairly easy to imagine various situations that might lead to liability for any dentist who fails to screen for SRBDs. One frightening scenario would be where a patient is seen by a dentist for a routine examination, then falls asleep while driving on the way home and hits a school bus. Patients with SRBDs can be very sleepy and, as a direct result, these patients may fall asleep at inappropriate times. Obviously, when a patient falls asleep while driving, there can be life-threatening consequences.

The ADA has recognized the growing prevalence of sleep disorders found in pediatric dental patients.

all patients for SRBDs and provide immediate care for those patients who present with significant signs and symptoms of SRBDs. In the meantime, until the next article in this series is published, ask all patients if they snore and if they would like to stop snoring. Asking all patients if they snore should legally qualify as a simple screening for SRBDs. After asking about the level of snoring, document that the patient was screened for SRBDs. If the patient is dangerously sleepy, provide a caffeinated energy drink and refer the patient to a sleep physician. The next article in this series will discuss in detail other techniques that may be used to screen patients for SRBDs. CM

With the passing of the ADA protocol, a reasonable and prudent dental practitioner should routinely screen

REFERENCES 1. American Dental Association [internet]. Chicago: American Dental Association; c2019. The role of dentistry in the treatment of sleep related breathing disorders [cited 2019 Aug 25]. Available from: https://www.ada.org/~/media/ ADA/Member%20Center/FIles/The-Role-of-Dentistry-inSleep-Related-Breathing-Disorders.pdf. 2. Sanders AE, Essick GK, Fillingim R, et al. Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort. J Dent Res. 2013 Jul;92(7 Suppl):70S-7S. 3. Al Lawati NM, Patel SR, Ayas NT. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis. 2009 JanFeb;51(4):285-93. 4. Redline S, Larkin E, Schluchter M, et al. Incidence of sleep disordered breathing (SDB) in a population-based sample. Sleep. 2001;24:A294. 5. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med. 1993 Apr 29;328(17):1230-5. 6. Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med. 2001 Dec 15;164(12):2147-65. 7. Caples SM, Garcia-Touchard A, Somers VK. Sleepdisordered breathing and cardiovascular risk. Sleep. 2007 Mar;30(3):291-303. 8. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008 Aug;31(8):1071-8.

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Common Problems with Digital Impressions â&#x20AC;&#x201D; and How to Avoid Them by Justin Chi, DDS, CDT chairside@glidewelldental.com

ith the increasing popularity of digital impressions, itâ&#x20AC;&#x2122;s important for the dental laboratory to develop an efficient and accurate method for placing data into production. At Glidewell, the Centralized Design Order Processing (CDOP) team was created to validate the quality of each scan you submit prior to sending it on for digital fabrication of the restoration. The CDOP team relays any issues with the submitted scan to the Customer Service team, which then works with you to make alterations or adjustments so that the quality of the restoration is not compromised.

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Because Glidewell successfully processes more digital impressions than any other lab, I decided to examine the data from our CDOP team to determine the most prevalent issues they see that would warrant a call to your office, and how to avoid this disruption in your day by solving the problem before it happens.

How to Avoid It

Below are the three most common digital impression problems seen by the Glidewell CDOP team. For each problem, I’ll explain how to recognize it, identify what most likely caused it, and offer tips and techniques for avoiding it.

Along with consistent effort, there are a few things you should double-check each time you perform a scan. Review the list below and get into the habit of running through each item mentally as part of your workflow until performing these checks becomes second nature:

ISSUE NO. 1: MISSING SCAN INFORMATION

As is the case with many tips and techniques, the key to superb digital impression scanning is to practice. The more you work with the scanner wand, the better you’ll be able to manipulate it in ways that are comfortable for both you and the patient, while still capturing the information you need.

1. Make a visual inspection of your results. Some intraoral scanners have a data verification process built into the software, which will automatically highlight areas of a scan where information is missing. This is an excellent resource, but if your scanner doesn’t include one — or even if it does — it’s still important to make your own visual inspection on the screen. With practice, you’ll quickly learn to identify the “holes” in your work, which, ideally, will allow you to recognize where rescanning is needed while the patient is still in the chair.

What It Looks Like When viewed on the monitor, areas of the impression will be visibly absent. In most cases, this issue requires the doctor to rescan the patient and send in new files, as any interpolation made by the lab is very likely to affect the fit.

How It Happens This one wins the award for “occurs most often” by a landslide. Whether you’re new to intraoral scanning or not, there are certain angles you’re required to achieve with the scanner wand inside the patient’s mouth that are always going to be difficult. The most commonly missing areas of digital scans are the mesial and distal surfaces of teeth adjacent to the preparation, which will create an issue in crafting a restoration with the proper contour and contacts. Keep in mind as you work that there are certain angles and distances from the teeth that will impact data acquisition as well.

2. As mentioned, some areas of the dentition are just plain difficult to scan and may require some creative hand, wand and light positioning to capture. Once you’re able to identify those areas for yourself through practice, start building a repertoire of approaches to have in your back pocket for when those circumstances occur. Remember that holding the wand at a particular angle in a particular way might work beautifully for one patient, but not for the next one whose mouth is a different size entirely. Develop your own list of “holds,”

Figures 1a, 1b: Mesial and distal surfaces of teeth adjacent to the preparation are the most-often missed areas when scanning (1a). Any difficult-to-access areas, like the opposing teeth in a posterior bite (1b), should be checked to confirm they were fully captured for a complete and accurate impression.

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set up your light source so that it’s easily repositioned as needed, and be willing to think on your feet and make adjustments as you go. 3. Turn to your scanner’s manufacturer for resources if necessary. The majority of intraoral scanners available today feature not just basic user instructions, but also a certain amount of fairly in-depth user training. Many scanner suppliers are willing to offer everything from advanced training videos online to in-person instruction to help you perfect your skills.

How to Avoid It It’s all about preparing for the scan. Taking the time to remove moisture completely from the area is essential to getting a full and accurate 3D model, and it saves you time in the long run by eliminating the need for rescans. Here are a few more tips to keep in mind to help keep moisture and the resulting distortion from being a problem: 1. Have the scanner ready on standby. Ensure the lens on the scanner’s wand is dry and free from smudges. 2. Suction excess saliva while air-drying the field. Have the patient refrain from closing his or her mouth.

ISSUE NO. 2: D ISTORTION CAUSED BY MOISTURE

3. Place cotton rolls in the lingual vestibules to help absorb moisture during mandibular scans. Cotton-roll material placed against the buccal mucosa can help control moisture during all scans.

What It Looks Like Areas of the impression will be visibly distorted or misshapen. When an intraoral scanner picks up anything that reflects back at it, such as saliva or other fluids, it can’t differentiate between that reflection and the rest of the image it’s capturing. The liquid reflections are worked right into the 3D model, leading to a model that relies on warped or rippled images. Depending on the viscosity and amount of liquid, it will either warp or entirely blot out the dentition beneath it, leading to models that don’t reflect reality or are missing information.

How It Happens Moisture is left behind when the doctor doesn’t isolate the area well enough with cotton rolls, doesn’t suction fully, or doesn’t use tools such as dry angles to keep things moisture-free while scanning.

4. If packing cord, remove retraction cord while hydrated. Then, use gauze and air-syringe to dry the field again. 5. If space allows and the patient can tolerate it, keep the saliva ejector in place as you scan. Note: Some intraoral scanners require the use of spray powder. If this is the case with your scanner, remember that the teeth must be completely dry before the powder is sprayed onto them. Also note that over-powdering the teeth with the spray, or applying it in uneven layers, can lead to distorted scans, just as moisture can.

Figures 2a, 2b: When too much moisture is present during digital impressions, the intraoral scanner picks up the reflection of the liquid and treats it like part of the dentition. This results in errors ranging from misleading shapes and textures on the teeth (2a), to the presence of actual droplets in the 3D image that blot out the dentition you’re trying to capture (2b).

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ISSUE NO. 3: M ISALIGNMENT IN THE BITE SCAN

which can cause interference, especially when the patient has a small mouth.

What It Looks Like

Digital impressions of the buccal are also prone to errors caused by an abnormal bite on the patient’s part.

Inaccurate occlusion in the bite scan may sometimes result in an impression where the bite shows as being open or misaligned in a way that doesn’t match reality. You may also see artifacts that interfere with the image, or distortions that create misshapen teeth or inaccurate bite alignment. Unfortunately, some errors that occur in the buccal scan may be difficult to detect at the impression phase, and may not actually reveal themselves until the restoration comes back with a bite that is too high and requires occlusal adjustment. This is why extra attention must be given to the scanning process when it comes to the buccal angle.

How It Happens Typical protocol for taking digital impressions involves three main scans: the lower arch, the upper arch and the buccal view. Of the three, the buccal view is particularly prone to artifacts and interference due to the cheeks and tongue,

How to Avoid It Providing clear instructions to the patient, and doing several visual checks to ensure that the bite at the time of scanning is the same as natural occlusion, are skills you’ve likely developed while taking traditional impressions in the past. The same skills apply here. The good news is that digital impressions tend to make it easier for patients to comply, as it’s much easier to relax and hold a normal position without trays and impression material in the mouth. 1. Before you begin to scan, establish the correct bite with the patient to allow for easier repositioning during the scan. Only activate the scanner once the patient’s bite has been verified, with the wand correctly positioned on the buccal. 2. Once you’ve completed the bite scan to establish the patient’s occlusion, inspect the 3D model thoroughly from a buccal view to verify that the contact points and intercuspation match the patient’s true bite. 3. Make sure to capture sufficient buccal data for the maxillary and mandibular scans, so that the software has more data points to align during the bite scan. Once you’ve identified the areas where your scans have fallen short of ideal in the past and where you might benefit the most from these tips, it’s a simple matter of practicing them consistently until they become a natural part of your workflow. At that point you’ll find yourself quickly rewarded with increased accuracy, not only in your digital impressions, but also in the final restorations that rely upon them. CM

Figures 3a, 3b: An unnatural or abnormal bite on the patient’s part can result in an inaccurate buccal scan (3a). Interference from the cheeks and tongue can also lead to missing data, which results in an impression that may or may not match reality (3b). Both issues create misaligned buccal scans that can result in an improperly fitting restoration.

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WATCH ONLINE Dr. Chi shares more tips at chairsidemagazine.com

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Forget Everything You’ve Learned About Digital Dentistry. It’s No Longer “In the Future.” It’s Here and Now.

Digital Impressions Received Over Time

In the past nine years, the number of digital impressions sent to dental labs has risen exponentially.1

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1. Glidewell internal data

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R&D CORNER

Utilizing AI to Produce Better Crowns, Faster by Sergei Azernikov, Ph.D. chairside@glidewelldental.com

nly a few years ago, artificial intelligence seemed like a futuristic — even fantastic — concept, but the truth is that AI has already taken root in our day-to-day lives. For example, when you get into your car and your smartphone already knows where you’re going and how long it will take you to get there — that’s AI. The machine-learning technology that powers AI initiatives has advanced to the point that the ongoing collection of large amounts of data — including the predictability of the route you take to work each morning — is paying big dividends.

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In fact, the AI used in your smartphone’s map app is surprisingly similar to technology now being leveraged in clinical dentistry. One notable example is found with new dental services that use AI to analyze radiographs to assist in diagnosis. A dentist can upload a patient’s radiograph to a website for a diagnostic reading. Using large amounts of data input by teams of diagnosticians, the AI algorithms can provide possible diagnoses and detect areas requiring additional examination.

HOW AI IMPROVES THE LAB PROCESS AND CROWN DESIGN

THE GLIDEWELL AI INITIATIVE Now, imagine what might be possible with a knowledge base of 20 million individual data sets. Engineers and technicians at Glidewell have collected 10 years of CAD restoration designs to create a mammoth database for future design proposals, and they are now using this information in what the company calls “Crown AI.”

Your digitized preparation is uploaded into the design software.

With each new CAD restoration, Crown AI expands on what it has already learned about ideal contacts, occlusion, shape and anatomy. And thanks to the science of artificial intelligence, the result of the storage and usage of this wealth of data is constantly improving the accuracy and precision of restorations produced at Glidewell. By the end of this year, the majority of crowns designed at Glidewell will be created with the benefit of machine-learning technology. The result will have a positive impact on your practice: better crowns made faster and delivered more quickly, enabling you to provide better service to your patients.

The software analyzes the patient’s tooth anatomy captured in the model and generates a proposed crown design enhanced by information derived from millions of successful restorations.

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R&D CORNER

If any modifications to the crown design are needed, the technician will make adjustments and this information is added to the stored data.

ARTIFICIAL INTELLIGENCE, AUTHENTIC RESULTS Consistency, accuracy and speed â&#x20AC;&#x201D; these are the hallmarks of crowns designed and manufactured by Crown AI. Given that automation is essential for modern manufacturing, Glidewell continues to harness the power of artificial intelligence. The result of this shift in production is a restoration that is back in your office in a few days, fits effortlessly and is affordable for you and your patient. And there is nothing artificial about that. CM

The finalized design file is sent to a milling machine, where the restoration is fabricated and then stained and finished by a technician.

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New Technology: Practice Disruption or Increased Production? by Carrie Webber, Chief Communications Officer and Co-Owner, Jameson Management, Inc. chairside@glidewelldental.com

hen I visit dental offices, I often see expensive equipment, like lasers, being used to hang lab coats. It happens all too often that a significant piece of technology is purchased, only to be forgotten because the motivation for its place in the practice quickly waned when faced with the next busy Monday morning. The hope was that the investment would begin paying for itself quickly, but new technology is often met with resistance, frustration and little, if any, use at all.

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How can you avoid this and make certain that your investment will generate sufficient returns and be embraced by your staff? At Jameson, we help doctors successfully navigate these exact business decisions. We recommend that doctors use four strategies before they make any significant investments. These strategies will help you integrate new technology into your workflow and get the most out of your investment.

1) Y OU MUST HAVE TEAM BUY-IN You have a vision in place for your practice. You know the type of quality dentistry you want to provide and how you want to provide it. The question is, does your team know your vision and are they on board with it? The same question needs to be asked about any investment in new technology that you are introducing into your practice. The truth is, if you don’t have buy-in from your team for the implementation of new technology, it will be difficult to integrate it into your workflow. You may be reflecting right now on the scanner, camera, laser, mill, or any particular piece of technology you purchased that failed to make an impact in your practice or was never used. How do you effectively engage your team to embrace and integrate the technology into your practice? An effective strategy to bring your team on board quickly is to involve them in the purchasing decision from the beginning. What technology are you considering investing in soon? Identify the members of your team who would be involved in using it, and involve them in the product demonstrations and research. Allow them the opportunity to be a part of deciding which device to purchase and why. Owning part of the decision will give your team a greater desire to see its implementation succeed — more than if the decision were made for

To ensure your team embraces new technology, bring them into the decisionmaking process from the start.

them without their role or opinion taken into consideration. Let’s say you are considering investing in a laser for your hygiene department. Communicate in clear terms to your entire team how and why this investment helps you progress toward your ideal practice vision. Include your hygienists in the product demonstrations, in hands-on courses and in the final decision of which product you purchase. Let them assist you in mapping out how they will train themselves and utilize the tool. Inviting them into the decision-making process gives them a stronger sense of ownership and a higher level of enthusiasm for the new technology, which increases your ability to incorporate the tool into your practice to generate growth and a return on your investment.

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Clinical research supports this idea. According to Dr. Charles Stangor in his book “Principles of Social Psychology,” groups tend to find implementation easier when decisions are made together. He states that group decisions are perceived as fairer than those made by individuals. Achieving buy-in can lead to a stronger sense of ownership and, ultimately, success of the tool.

2) TRAIN UP TO LEVEL UP It is critical to prioritize training time for your new technology. If you don’t make time to train yourself and your team in the early months of implementation, it is less likely you will feel confident in the use of the tool and its place in your practice. You have to set your team up for success.

Included with the purchase of the glidewell.io™ In-Office Solution, doctors and their team members receive training in two phases: at the dental office during installation and, later, with Glidewell Clinical Education in Newport Beach, California.

Dr. John Jameson states to this day that if you are going to invest in technology for your practice, please invest in the training for your team as well. For example, our team at Jameson has recently taken the plunge and invested in brand-new company-wide software. The learning curve has been steep. But early on, we invested a significant amount of time in training with the software company’s trainers so that we were set up to succeed instead of struggling in the deep end, trying to figure it out along the way. Change is difficult and doctors must give themselves the space and grace necessary for these tools to become fully optimized in their practice. Invest the time at the beginning to build your team’s competency and confidence. You will be glad you did.

3) B EWARE OF INEFFECTIVE SCHEDULING It is important that you constantly monitor the effectiveness and efficiency of your new technology from the beginning. To do this, create a clear system of analysis for every step of the procedures that will utilize the new technology. These time and motion studies will give you an estimation of how much time your appointments or procedures will consume using the new technology. Your scheduling coordinator will then be able to block out the correct amount of time and avoid scheduling overlaps and inefficiencies. Motion studies also give your team a clear map of how the daily appointments and procedures will operate with the new technology and enable

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your staff to become confident in adopting the technology quickly. You do this by: • Creating a clear procedure analysis of all the procedures the technology will be involved in for everyone to follow. • Conducting regular time and motion studies to give your scheduling coordinator the information they need to block out the correct amount of time. In Figure 1, you’ll see an example of a time and motion study document for a single-appointment crown procedure using the glidewell.io In-Office Solution. Mapping out the steps in the procedure and the time required for each one gives you an accurate idea

of how much time you need to reserve for the procedure. It also informs everyone on the team of their responsibility and role with this new tool. As you and your team gain competence with the fastmill.ioâ&#x201E;˘ In-Office Mill, you will want to repeat this exercise at a later date to measure your time again and see if it has changed. If it has, you can make adjustments to your scheduling to

keep your practice running efficiently and your patients happy. As you grow more accustomed to your new technology, proceed at a comfortable pace that works best for you and your team. Make sure you schedule sufficient time for your appointments that require you to use your new technology. Give yourself

time to adjust to the learning curve so that everyone involved is happy with the experience and the result, especially your patients. If you consistently run time and motion studies in the early months of using your new technology, you can adjust your scheduling accordingly as your skill and efficiency improve. Eventually, you will find a consistent amount of time that you

SINGLE-APPOINTMENT DENTISTRY TIME AND MOTION STUDY SHEET Objective: Increase efficiency within each step of the single-appointment procedure. DATE OF STUDY:

START TIME OF STUDY:

TEAM MEMBER:

END TIME OF STUDY:

UNIQUE ROLE:

TOTAL TIME OF STUDY:

ACTIVITY NAME

PER ACTIVITY TIME

EFFICIENCY NOTES

Greet/Seat/Review/Anesthesia

Begin Documentation/Pre-Op Photo & Xray

Initial Impression/Scan - If Needed

Preparation of Teeth

Tissue Management

Intraoral Scanning

Design of the Restoration

Figure 1: Motion studies give you visibility into how your new technology impacts your workflow down to the minute.

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CARE THAT’S RIGHT FOR YOUR BUSY

Ask your dentist about same-visit crowns with the glidewell.io™ in-office solution

Communicating with your patients about the benefits of your new technology, both verbally and through your marketing efforts and patient education materials, is vital to the success of the tool.

can use to block out your schedule with confidence. Until then, stay conservative, patient and persistent.

4) D ON’T FORGET TO SPREAD THE WORD If you invest in an exciting piece of new technology, you need to tell people about it. Otherwise, how will anyone know you offer this great new service, and how will you ever get to practice the type of dentistry you really want to be known for? Not only is it important to plan some marketing campaigns for your existing and potential patients, but it is also important that your team can confidently communicate the benefits of your new technology to your patients every day. You can encourage your team to discuss new technology with patients by: • Having your team practice and develop their verbal skills at team meetings. Discuss how you are going to introduce and talk about

the new tool or service at your daily huddles to keep it front of mind. • Promoting your new technology on social media, in emails, on the signage in the office and anywhere you can. Remember the marketing “Rule of Seven,” which states that a person has to hear, see, feel and experience a message up to seven times before they act. You must consistently repeat your message. Repetition is the key to your current and potential patients understanding the value of this new technology in your practice. • Continuing to hone your skills on how to educate your patients on this new technology. You have to give your patients the tools to talk about you. Ask your happy patients for referrals and reviews. They’ve experienced your new and improved care firsthand, and all it takes is for you to ask them to tell their friends and family about their experience.

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Your new technology can either be a disruption or an opportunity to streamline your practice, increase growth and see a return on your investment. It all comes down to how you and your team choose to implement it. Be proactive. Lead your team with clarity on how this benefits your patients, the practice and each of them as members of your team. Train them on the new technology, teach them how to adjust the schedule accordingly, and remember to let everyone know about your new technology or service. You are doing great things to stay at the forefront of dentistry, and that’s worth talking about to your patients and anyone who will listen. Putting these steps into action will help prevent your new investment from becoming a very expensive coatrack. CM For more information on the practice-management consultation services offered by Jameson Management, Inc., contact Carrie at cwebber@jamesonmanagement.com or visit jamesonmanagement.com.

time to take a

CLOSER LOOK There’s more to discover with Jameson. Whether you are looking for a plan of action to achieve practice growth, considering bringing in associates or seeking systems to support your productive practice, Jameson has programs just for you. Building on 30 years of experience working with dental professionals, you will find caring advisors with a suite of services available such as: • Practice Evaluation • One and Two Day Training Sessions • In Office Coaching Programs • Website Development • Online Marketing Strategies Discover what’s possible for you and practice with the expert advisors at Jameson. Call today to learn more!

Schedule a complimentary Jameson Discovery Call with Jameson’s owner, Carrie Webber to discuss your practice goals today! Mention Chairside Magazine.

877.369.5558 • info@jmsn.com • www.jmsn.com

The 14 women dentists who participated in Guiding Leaders (from left to right in back row: Drs. Susan McMahon, Jill Frazier, Sat Kartar Khalsa, Larissa Figari-Goller, Nidhi Taneja, Danielle Dey, Stacy Spizuoco and Joy Poskozim; from left to right in front row: Drs. Shefali Shah, Keyla Springe, Ensy Atarod, Taylor Manalili, Mary Shields and Lan Chi Le) along with Glidewell Executive Vice President Stephenie Goddard (pictured in green).

My Transformational Journey as a Guiding Leader by Jill Frazier, DDS chairside@glidewelldental.com

n April 2019, I began an exciting yearlong journey as a participant in Guiding Leaders, a leadership development program for women in dentistry that was created by Glidewell Executive Vice President Stephenie Goddard. Over the past year, the program has provided 14 women dentists from across the nation with high-level training designed to cultivate our leadership skills and prepare us to be influencers in dentistry.

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In Missoula, Montana, I have the privilege of providing a full scope of general and cosmetic dentistry services at Missoula Dental Arts.

When I discovered that Guiding Leaders was accepting applications for its inaugural year, I was immediately intrigued. The new program sounded like a tremendous opportunity for women dentists who are interested in elite leadership training, which is rarely offered, even among the wide array of continuing education courses that are available on practice management. In the mid-’90s, when I graduated from dental school, women represented less than 36% of dental school graduates. Now, according to the ADA, that number has increased to approximately 50%. However, this does not correlate to the number of women dentists in leadership positions, or on the podium at dental conferences. For women who are interested in pursuing these roles, Glidewell has provided a dynamic opportunity for us to groom our leadership skills. Even though Guiding Leaders sounded like it would be a fantastic experience

I would not want to miss, I wondered where I would find the time to complete the application process while operating a busy dental practice. Yet as the deadline approached, I could not stop considering the benefits of this type of women’s leadership development program, nor the countless times throughout the years I’d had conversations with female colleagues who had faced similar professional challenges. In other industries, women have attained great success within their respective fields. There are numerous bestselling books, such as “Lean In” and “Nice Girls Don’t Get the Corner Office,” in which the authors encourage readers to adopt management styles or communication techniques that have successfully worked for their male counterparts. However, in my experience, trying to employ these techniques has been counterproductive, especially considering the dynamic inherent within my dental practice, where I function in

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several capacities: boss, coworker and dental care provider. Due to the increasing diversity within our profession, there is a growing need for different leadership models. Therefore, I am extremely grateful not only that I prioritized the Guiding Leaders application process, but also that the committee selected me to embark on this amazing journey. The first day of the program started in Irvine, California, with a focus on developing and implementing an outward mindset. This two-day course was taught by the renowned Arbinger Institute, which has worked with organizations worldwide. During our sessions, we learned how to resolve challenges and achieve breakthrough results by applying a different way of thinking. The course demonstrated how our actions impact the performance of those around us and equipped us with practical strategies we could implement immediately to generate results in our dental practices.

In the following months, through online and classroom sessions, we continued learning invaluable tips and techniques from various industry-leading experts from companies like VitalSmarts, Eloqui and Glidewell, which utilized its Clinical Education department to teach a few classes. In a course on crucial conversations, our instructor provided us with practical tools that showed us how to master challenging situations and foster teamwork in our offices.

Dr. Sat Kartar Khalsa (left) interacting with Dr. Taylor Manalili. During our Guiding Leaders courses, we had a variety of learning formats, including individual and group exercises and one-on-one discussions.

With insight from bestselling author Dr. Shawn Andrews, we began understanding the power of perception and how to examine barriers that contribute to the leadership gender gap. Her instruction was further enhanced by a DISC behavioral analysis that was provided by Glidewellâ&#x20AC;&#x2122;s leadership experts. The companyâ&#x20AC;&#x2122;s in-house team showed us how to tailor our strengths to more effectively meet the needs of those around us. They administered an emotional intelligence assessment and began showing us how to cultivate the core competencies that high-level leaders possess.

Our instructor Mike Foster, founder and CEO of Id8TE, taught us about the power of mindfulness at the Glidewell Clinical Education training center in Louisville, Kentucky. He showed us how we can implement this technique to strengthen and improve our critical leadership skills.

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During our session with Dr. Shawn Andrews (pictured in blue) at the Glidewell Clinical Education training center in Louisville, Kentucky, we learned how to examine barriers that contribute to the leadership gender gap and how to apply practical tactics to improve our practice.

To effectively lead in dentistry and receive invitations to speak, itâ&#x20AC;&#x2122;s crucial to develop an ability to deliver engaging presentations. To refine these important skills, we had the opportunity to be recorded on camera in different scenarios, and to evaluate those recordings while receiving feedback from the experts and each other. Even though at that point we were less

than halfway through the program, we had already learned so much that some of the women had begun accepting speaking opportunities where they could implement the strategies and skills that they were now honing. By developing the Guiding Leaders program, Glidewell has demonstrated leadership in the field of dentistry by recognizing the importance of em-

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powering a new generation of women leaders. They have created an exceptional platform for elevating women in dentistry to new levels. Participating in Guiding Leaders has been one of the most life-transforming professional opportunities I have experienced. Thanks to Glidewell, we are well on our way to being influencers in our practices, communities and dental profession. CM

Glidewell Executive Vice President Stephenie Goddard being interviewed by Chairside® magazine writer Aleesha Chaney about the Guiding Leaders Summit taking place in April.

Interview with Stephenie Goddard: An Inside Look at the Guiding Leaders Summit 2020 Interview by Aleesha Chaney chairside@glidewelldental.com

his spring, Glidewell will present the inaugural Guiding Leaders Summit, a two-day conference designed to empower women in dentistry. This dynamic event will take place April 24–25 at the Paséa Hotel & Spa in Huntington Beach, California. The visionary behind the Guiding Leaders Summit is Stephenie Goddard, executive vice president of Glidewell. Over the past several months, she has been working diligently with her team to create a phenomenal event that will provide women a well-rounded experience and offer tools and training in three key areas: clinical dentistry, leadership development and interpersonal wellness.

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CHAIRSIDE ÂŽ MAGAZINE: What inspired you to create the Guiding Leaders Summit? STEPHENIE GODDARD: In talking with women in dentistry, I discovered that when they are in dental school, they receive extensive clinical training. However, that training typically does not include courses on how to successfully operate a dental practice. And even after they graduate, there still are not many continuing education opportunities related to leadership development or managing a business. It is important to have training in these other areas if clinicians are going to be successful in dentistry. I believe the Guiding Leaders Summit is one way Glidewell can help equip women to become well-rounded business owners. CM: What types of courses will be offered during the summit? SG: We will have a variety of courses, including one that provides the latest tips and techniques for enhancing the quality of crown & bridge restorations. There will be a course that helps clinicians choose the right cutting-edge technology to grow their practice. We want to show them how to successfully incorporate digital technology into their office workflow. We will also have a course on how to reduce stress by unlocking the power of mindfulness. Life and work can be stressful regardless of what field you work in, so we want to equip attendees with tools that help them effectively manage stress. In addition, there will be courses related to developing interpersonal skills and managing people. We want to empower women to become more effective communicators and cultivate their leadership skills. CM: One great aspect about the summit is that it is designed for all women in dentistry, including hygienists and office staff. If a dentist wants to send her or his entire fe-

In April 2019, Goddard launched the Guiding Leaders program, which is a yearlong training opportunity for women in dentistry. Pictured above, the inaugural class of Guiding Leaders participated in a course taught by bestselling author Dr. Shawn Andrews about understanding the power of perception and leadership.

male team to the event, what do you have planned that can benefit them? SG: In addition to classes on clinical dentistry, we will have a course on social media. As a busy clinician, you may not have time to treat patients while simultaneously managing your social media platforms, so this is an area where support staff can be trained to help you expand your practice. We will also have a course taught by a registered dental assistant. It is important to leverage your whole team in order to maximize growth within your practice. And we will have other courses covering topics such as generating positive cash flow, which not only is related to managing business finances but also deals with personal finances. This is practical information that anyone can benefit from, regardless of their role within the practice.

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CM: I know that women can earn up to nine hours of continuing education credits by attending both days, and they can attend eight courses. They do not have to preregister for courses either, right? SG: Yes, we want to give everyone some flexibility because sometimes at conferences you wish you could select a different course. If someone arrives at the summit and notices another course theyâ&#x20AC;&#x2122;d rather take, then they have the option to attend that session instead. Or if someone wants only clinical training, they can select those courses. If they prefer a combination of courses, they will have that option as well because all courses will be offered at least twice. CM: Dr. Rella Christensen, a renowned author, researcher and

SG: There will be a panel discussion where women can ask questions and get answers from HR and legal experts about how to manage their practice. If they have questions such as how to handle pay raises or determine annual bonuses, this is a chance to get answers from experienced professionals. We will also have a marketplace where women can visit exhibitor booths and update their professional headshots free of charge. And each morning, yoga or tai chi will be offered on the beach for anyone who wants to participate. CM: What a great way to start the day! Goddard has worked hard to create an exceptional conference for women that is unlike other events in dentistry. Her vision for the summit is to provide women a chance to explore cutting-edge dental procedures, enhance their leadership skills and build a strong network with female colleagues.

lecturer, will be the keynote speaker. What can women expect to hear from her that will empower them in their daily practice?

have a good support system. That is another benefit to attending the summit. Can you talk to me a little about that?

SG: Dr. Christensen will discuss the latest developments related to material science. As the cofounder of the Clinicians Report (CR) Foundation®, an educational research and clinical validation institute, Dr. Christensen has conducted extensive research that gives dentists confidence in the materials they select to restore their patients’ smiles. Additionally, Dr. Christensen will share her journey in dentistry. So many women admire her, and they probably have not heard her story. This will be a chance for them to hear something new and to be inspired by a woman who is considered an icon in dentistry.

SG: Yes, one of the purposes of the Guiding Leaders Summit is to help women build a strong network. It is very important to have a good network of other women who have been through what you are going through — women who can coach you by sharing their advice and providing insight on how to navigate different decisions. You can best achieve all of what you want in your career if you have great mentors and networks around you, so we wanted to create an opportunity for women to connect with professionals in the same field and to establish this type of support system.

CM: Over the past year, as you have worked with Guiding Leaders, I’ve heard you mention how important it is for women in dentistry to

CM: The summit sounds like a great opportunity for women in this profession. Is there anything else you have planned during the event?

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SG: Yes, the summit is going to be two full days, and yoga is an excellent way to clear your mind and focus on learning. CM: I know you selected the Paséa Hotel & Spa because one of the goals of the summit is to create an environment where women can be refreshed and rejuvenated as well. SG: Yes, we wanted to choose an environment that is conducive to learning, which the Paséa definitely offers. It is a spectacular oceanfront destination that is a great location for continuing education. Also, it is a peaceful resort for unwinding. We want women to come ready to learn and then return to their practice refreshed so they are ready to make a bigger impact in dentistry. CM: The inaugural summit is still a couple of months away, but have you started thinking about the future? What’s in store for Guiding Leaders? SG: We plan to start accepting applications for the next Guiding Leaders program in April. Also, our goal is to continue expanding the summit in terms of size and the scope of con-

tent that is offered. We want to build Guiding Leaders into an ongoing community of women who can support each other and become influencers in dentistry. We are eager to kick off this event and to receive feedback so we can tailor it to best meet the needs of the women it is designed to support.

CM: This sounds like a phenomenal experience. Where can women get more information?

CM: Thank you for your time. We look forward to seeing you at the Guiding Leaders Summit in April.

SG: They can get more information and register to attend by visiting guidingleaders.com.

SG: Thank you for having me. CM

At the Guiding Leaders Summit, the 14 women dentists who participated in the yearlong Guiding Leaders program will be recognized during a graduation ceremony and cocktail reception. (From left to right in the back row: Drs. Joy Poskozim, Sat Kartar Khalsa, Stacy Spizuoco, Susan McMahon, Taylor Manalili, Mary Shields, Danielle Dey and Jill Frazier; from left to right in the middle row: Drs. Ensy Atarod, Lan Chi Le, Shefali Shah and Nidhi Taneja; front row: Drs. Keyla Springe and Larissa Figari-Goller.)

Registration for the Guiding Leaders Summit includes a two-night stay at the luxurious PasĂŠa Hotel & Spa, an oceanfront resort in Huntington Beach, California. The venue is conveniently located steps away from the beach, and it has plenty of amenities for conference attendees, including shops and eateries.

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WATCH ONLINE See the video interview at chairsidemagazine.com

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An Inside Look at Implant Dentistry’s Essential Textbook Interview with Randolph R. Resnik, DMD, MDS chairside@glidewelldental.com

irst released in 1993, “Contemporary Implant Dentistry” has become the standard textbook in implant education and one of the best-selling textbooks in the history of dentistry. With the recent arrival of the long-awaited fourth edition of the textbook, we sat down with its primary author, Dr. Randolph Resnik, to discuss the new content clinicians can expect, the rise of implant dentistry in the general practice, and how the book carries on the legacy of the late Dr. Carl Misch.

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CHAIRSIDE ® MAGAZINE: Can you talk about the very first edition of “Contemporary Implant Dentistry” and what implantology was like back in 1993? DR. RANDOLPH RESNIK: In the early days of implantology, back in the 1980s and 1990s, there were almost no textbooks, no real accepted protocols in the profession. The first edition of “Contemporary Implant Dentistry” took almost five years to complete and was based on the early, pioneering principles and classifications of Dr. Carl Misch. When this book was first published, it was the only implant textbook that encompassed a comprehensive overview of the surgical, prosthetic and maintenance phases of implant dentistry. This book was considered the complete “encyclopedia” of all aspects of dental implant treatment. CM: How would you describe the major differences between the new, fourth edition of “Contemporary Implant Dentistry” and the third edition of the book? RR: The fourth edition has been updated to include the most recent science-based surgical concepts and procedures. All chapters have been extensively updated, and there are over 20 completely new chapters. There is now a total of 42 chapters, with over 1,300 pages and 2,700 detailed clinical images and illustrations. CM: How do you think “Contemporary Implant Dentistry” has affected implantology at large? RR: This book has had a significant impact on the profession. From an academic standpoint, most universities and residency programs still use this book as their sole textbook to teach implantology, and clinicians use it as their guide to protocols and techniques. Most concepts of modern-day implant dentistry are based on the

In the late ’80s, Dr. Carl Misch (right) developed the principles and classifications that served as the foundation of “Contemporary Implant Dentistry.” Drs. Misch and Randolph Resnik went on to develop several essential textbooks on oral implantology, and Dr. Resnik carries on that legacy with new editions and textbooks that capture the latest research, techniques and protocols.

principles and techniques contained in this book. “Contemporary Implant Dentistry” as well as our more recent book, “Avoiding Complications in Oral Implantology,” are solely based on current literature and research. Therefore, the reader is educated on the most up-to-date information available based on accepted science. CM: What do you think are some of the biggest developments and changes in the field of implantology since the previous edition of “Contemporary Implant Dentistry” was released? RR: Almost every aspect of implant dentistry has changed since 2007. There have been dramatic advancements in technology that have made the techniques more predictable and successful. First, if you look at preoperative evaluation, with the recent integration of CBCT scanning and software programs used for diagnosis, interactive treatment planning and guided surgery — this has allowed clinicians to practice with the highest degree of accuracy and precision.

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Prosthetically, with Glidewell being at the forefront of new research & development, the restorative phase of implant dentistry has become so much more predictable with respect to esthetics and function. The restorative materials and techniques available today are far superior to what we had in the early days of implant dentistry. As for the maintenance phase of implant dentistry, we now have accepted protocols to treat peri-implant disease predictably. So, basically all facets of implant dentistry have changed dramatically. CM: What changes in the book have been made with regard to the surgical placement of implants? RR: First, we have added a new chapter on basic surgical protocols and armamentarium. This chapter encompasses all phases of implant surgery, including incision design, flap reflection, modification of bone, tissue manipulation, and suturing techniques. This new chapter also features a comprehensive overview and discussion of various options for surgical instrumentation.

As for the surgical placement of implants, a new chapter was written mainly because of research & development and advancements like the Hahn™ Tapered Implant System (Glidewell Direct; Irvine, Calif.). Because of this surgical system, we now have various predictable surgical protocols specific to the location and bone density present in the implant site. Secondly, because of the design of these implants, we have added new chapters to discuss accepted protocols with immediate placement and immediate load protocols.

ters that represent the cutting edge of implant dentistry?

CM: Have there been any changes made to the bone grafting protocols in the new book?

CM: Implant treatment has certainly become more widely adopted since the last edition of this book was released, especially in the general practice. Have you made any changes to the book as a result?

RR: Yes. Because of advancements and research in this field, I have added completely new chapters on atraumatic extraction and socket grafting, guided bone regeneration techniques, and intraoral and extraoral autogenous block grafting. In addition, I have included a dedicated chapter on regenerative materials, specifically an overview with recommendations on the types of bone and membranes to be used with these procedures.

RR: There is a new chapter on Botox® (Allergan; Madison, N.J.) and dermal fillers. When researching new topics for this book, I was amazed at the minimal amount of literature pertaining to these subjects. Therefore, we have included a very detailed chapter describing the use of Botox and dermal fillers in the field of oral implantology. This chapter includes step-by-step pictorial protocols on the various uses of these materials.

RR: This is our 36th year at the Misch International Implant Institute, and in the early days, most of the attendees at our courses were specialists — oral surgeons, periodontists and prosthodontists. Now, 95% of the clinicians taking our courses are general dentists. So we’ve definitely tailored a lot of the

book to the situations, indications, procedures and techniques most relevant to the general practice. However, I view the book as a comprehensive resource for all clinicians treating patients, regardless of their experience level. Dr. Gordon Christensen reviewed the book, and I think he said it the best way: “‘Contemporary Implant Dentistry’ is highly recommended as an up-to-date resource for all clinicians which is based on the highest levels of scientific evidence and research. It utilizes current academic and clinical standards which is a one-stop reference for dental students, general practitioners and specialists who wish to update their knowledge on all aspects of surgical oral implantology.” CM: Where can dentists find this wonderful new book? RR: The fourth edition of “Contemporary Implant Dentistry” is available at Amazon or Elsevier’s website. CM: And finally, can you speak to how this book continues to

CM: We know the prevalence of peri-implant disease is increasing. Have you made any changes concerning this subject? RR: Peri-implant disease is a significant issue and a commonly discussed topic in our field. I have added two chapters written by world-renowned periodontist Dr. Jon Suzuki on the treatment of peri-implant disease and maintenance protocols to decrease the complications and morbidity of implants. These accepted protocols, which include a new detoxification and bone grafting technique, contain very valuable information for all clinicians. CM: Are there any other new chap-

Since the release of the first edition of “Contemporary Implant Dentistry” in 1993, the textbook has continually shaped the field of implant dentistry by standardizing procedures based on the latest research-based principles.

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embody Dr. Misch’s legacy and his philosophy to make research-based principles the standard in implant dentistry?

The fourth edition of “Contemporary Implant Dentistry” has been updated with the very latest in science-based surgical and restorative concepts, including 20 completely new chapters covering the latest developments in implantology.

RR: After Carl became ill, he and I sat down and discussed how to best move forward with the Misch Institute and his legacy. His goal always was to continually elevate the standard of care in implant dentistry. Carl commonly used the quote, “Share what you have learned.” Therefore, I have dedicated this book to Carl, to share what we have learned as well as continue to learn. I believe this book will carry on his legacy and help implant dentistry reach the next level. CM

Dr. Gordon Christensen reviewed the book, and I think he said it the best way: “‘Contemporary Implant Dentistry’ is highly recommended as an up-to-date resource for all clinicians which is based on the highest levels of scientific evidence and research. It utilizes current academic and clinical standards which is a one-stop reference for dental students, general practitioners and specialists who wish to update their knowledge on all aspects of surgical oral implantology.”

“The Latest and Greatest: Current Hot Topics and Protocols in Implant Dentistry” Thursday, February 27, 2020 8:00 a.m.–noon Marriott Marquis Houston, TX

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ATTENDING THE ICOI WINTER SYMPOSIUM? Don’t miss this joint special lecture presented by Glidewell and the Misch Institute

Enhancing Bone Regeneration with the Use of Platelet Concentrates by Randolph R. Resnik, DMD, MDS chairside@glidewelldental.com

n implant dentistry today, many clinicians strive to implement procedures that enhance and accelerate the predictable rates of healing. To increase the regeneration of hard and soft tissues, the use of growth factors is commonly integrated into the surgical protocol. There are more than 50 known growth factors that have been identified in the healing process. Most of the factors enhance the formation and mineralization of bone,

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induce undifferentiated mesenchymal cells to differentiate into bone cells, and trigger a cascade of intracellular reactions.1 One popular source of growth factors used in implant dentistry is blood concentrates — most specifically, platelets. The platelet, also called a thrombocyte, consists of blood cells that play a crucial role in hemostasis and wound healing. Platelets have a life span of approximately 7–10 days and set the pace of wound repair by releasing their growth factors immediately after the initiation of the clotting process.2 These platelet-derived growth factors have been shown to enhance collagen production, cell mitosis, blood vessel growth, cell recruitment and cell differentiation (Fig. 1).3

PLATELET CONCENTRATE CLASSIFICATION The two most utilized and studied platelet concentrates in implant dentistry today are platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The first-generation blood concentrate, platelet-rich plasma, was introduced by Marx in 1998. His studies showed bone maturity to be twice as effective

with the use of PRP in grafted sites, and the addition of PRP increased bone density up to 30% in healed sites.4 A second-generation blood substitute, platelet-rich fibrin, was first described by Choukroun in 2001. PRF has been shown to be very effective in the release of important growth factors present in platelets, such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-ß), insulin-like growth factor (IGF), fibroblast growth factor (FGF), and epithelial growth factor (EGF).5 Multiple clinical studies with PRF have shown greater soft-tissue healing, enhanced healing of grafted bone, promotion of angiogenesis and faster wound healing.6-8 This concentrate has become popular in implant dentistry, as it has a much simpler processing protocol compared with PRP.

PLATELET-RICH CLOT The PRF clot is a natural-based biomaterial that is obtained from an autogenous blood harvest without the use of anticoagulants or biomedical modifiers. This gel-type fibrin network contains a high concentration of

EGF Epithelial growth factor Increases angiogenesis and epithelial mitogenesis

PDGF Platelet-derived growth factor Stimulates fibroblast mitogenesis and collagen synthesis

TGF-ß Transforming growth factor beta Enhances wound healing via endothelial angiogenesis

platelets and white blood cells, which release the growth factors at the surgical site.9 The internal organization makeup of platelet-rich fibrin is unique, as it contains three adhesive molecules — fibrin, fibronectin and vitronectin — that result in a highly elastic, matricial mesh architecture. This complex three-dimensional structure allows for a longer release of growth factors, as compared with PRP. As the platelets degranulate, a sustained release of growth factors may range from a time period of one to four weeks.10

DIFFERENCES BETWEEN PRF AND PRP The PRF clot has become very popular in clinical oral implantology in comparison to the PRP process because it: • Is naturally polymerized and requires no chemical use (PRP requires a coagulant) • Requires a conventional, single-spin centrifuge (PRF) vs. two centrifuge spins (PRP) • Has a slower release of growth factors in comparison to PRP • Exhibits greater cell migration and proliferation • Contains a more advantageous fibrin network that stores cytokines and growth factors • Has better healing properties than PRP • Requires fewer disposables, reducing cost

FGF Fibroblast growth factor Increases angiogenesis, epithelialization, and fibroblasts

PLATELET

PROTOCOL FOR PREPARATION OF PLATELET-RICH FIBRIN a. Obtaining the Blood Sample

IGF Insulin-like growth factor Enhances rate and quality of wound healing via bone matrix formation and cell replication

VEGF Vascular endothelial growth factor Increases endothelial growth factor and angiogenesis

Figure 1: Bone growth factors released by platelets.

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The standard protocol for PRF preparation begins with the venipuncture technique, which involves obtaining approximately 9 ml of blood collected in a sterile, glass-coated plastic tube without anticoagulant (red tube) (Table 1 and Figs. 2–7).

Table 1: Venipuncture Technique Step 1: Select site for venipuncture (e.g., antecubital fossa, dorsum of the hand or wrist).

Figure 4: The site is cleaned with alcohol gauze.

Step 2: Place tourniquet approximately 3–4 mm above entry site. Step 3: Identify the vein location and trajectory. If visualizing the vein is difficult, the following may be used to ease the location of veins: light tapping on the site, warm and moist towel, nitrous oxide, or a vein locator. Step 4: Clean injection area with alcohol gauze.

Figures 2a, 2b: Common venipuncture sites include the dorsum of the hand (2a) and antecubital fossa (2b).

Step 5: Venipuncture with a vacutainer, butterfly needle or catheter. Enter tissue and vein to collect the blood sample:

Figures 5a, 5b: Skin is pulled tight and needle is directed at a 30-degree angle (5a). Vein is entered; needle angle is reduced and slightly advanced (Vacutainer® technique) (5b).

• Pull skin in opposite direction of needle. • Ensure needle bevel is facing upward. • Tissue is entered at a 30-degree angle. • Perforate vein. Then, decrease angle and advance needle slightly. • Remove tourniquet. • Obtain approximately 9 ml blood collection in a sterile, glass-coated plastic tube without anticoagulant (red tube).

Figure 3: A vein finder allows for ease of locating and determining the trajectory of veins.

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Figure 6: Blood sample is obtained in a sterile tube without anticoagulant.

Table 2: Single-Spin Platelet-Rich Fibrin Protocol

Figure 7: Alternative venipuncture technique: A butterfly needle is used to obtain the blood sample.

b. Blood Sample Centrifuge When using a plain collection tube (without anticoagulant), the centrifuge process activates the coagulation process as soon as the blood comes into contact with the tube walls. Therefore, it is imperative that there is no extended delay between obtaining the blood sample and the start of the centrifuge process. If an extended delay occurs, the fibrin clot will be less distinct. Ideally, the centrifuge should spin at approximately 2,700–3,000 rpm for about 10–12 minutes. c. Blood Concentrate Two different intrinsic processes result from the high-speed centrifuging of a blood sample: blood coagulation and separation of the blood elements. The centrifugal force separates cells of different densities, which results in three layers of blood product: The top layer consists of an acellular supernatant platelet-poor plasma (PPP), the platelet fibrin clot forms the middle layer, and the bottom layer is composed of concentrated red blood cells. The top layer (PPP), which contains a small percentage of platelets, may be discarded or used to hydrate the particulate bone. The middle layer (PRF clot) may be used as a membrane or integrated with the particulate bone. The bottom layer (red blood cells) is discarded. (See Table 2 and Figs. 8–13.)

Step 1: Immediately place blood collection tube in centrifuge for 10–12 minutes at approximately 2,700–3,000 rpm. Make sure the centrifuge is balanced with an even number of tubes and an equal volume of liquid. Step 2: Carefully remove the blood sample tube from the centrifuge. Three distinct layers will be present: • Top layer: Platelet-poor plasma (PPP) • Middle layer: Platelet-rich fibrin (PRF) • Bottom layer: Red blood cells (RBCs) Step 3: Remove the rubber top from the blood sample tube. Using a sterile 5 ml syringe with a blunted needle, draw off the yellow liquid top layer (PPP). This may be discarded or added to the particulate graft material. Step 4: Using sterile college

Figure 8: For the PRF preparation technique, a sample is placed in the centrifuge, which is capable of reaching a speed of 3,000 rpm.

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pliers (pick-ups), remove the fibrin clot (PRF) from the center of the tube. If coagulated RBCs are attached to the clot, they may be removed with scissors and discarded. Step 5: PRF processing: • Membrane Place the fibrin clot into a PRF box or biocompress instrument to compress the clot. This will result in an approximately 1-mm-thin membrane. The PRF membrane is then placed over the graft site membrane, serving as a double membrane between the primary membrane (e.g., collagen) and the soft-tissue flap. • Graft incorporation The PRF clot may be cut into small pieces and added to the graft. In addition, the PPP may be added to the graft if more hydration is required, as the PPP does contain a low concentration of platelets.

Figure 9: After 10–12 minutes of centrifuge spinning, three distinct layers are present: acellular platelet-poor plasma (PPP) on top, the PRF clot in the middle, and red blood cells (RBCs) on the bottom.

Enhances rate and quality of wound healing via bone matrix formation and cell replication

PPP

Discarded or added to graft Compression device

PRF Membrane RBC Discarded

Figure 10: PRF processing: The centrifugal force separates cells of different densities, which results in three layers of blood product available for processing.

Figure 11: The fibrin clot is removed.

Figure 12: Use of a biocompress for a membrane.

Increases endothelial growth factor and angiogenesis

CLINICAL USES OF PLATELET-RICH FIBRIN Platelet-rich fibrin has been used in many oral implant procedures, ranging from guided bone regeneration to procedures requiring a hemostatic agent (Figs. 14â&#x20AC;&#x201C;18). Guided bone regeneration: With bone augmentation procedures, PRF may be used as either a membrane or added to the particulate bone grafting material. Studies have shown that PRF is advantageous in healing during regenerative procedures either as a membrane or when added to particulate bone.11 Because the PRF membrane resorbs rather quickly (approximately seven days), it is not the most ideal membrane to be used to prevent soft-tissue invasion. Therefore, the PRF membrane is commonly placed over the primary membrane (e.g., collagen) to aid in hard- and soft-tissue healing. Sinus augmentation: During sinus augmentation procedures, PRF is often used with the graft material, as a second membrane over the lateral wall, or as a membrane during crestal approaches. Choukroun et al. showed that when PRF was added to freeze-dried bone allograft, there was a reduction in healing time prior to implant placement.12 Diss et al. showed that PRF used with the osteotome crestal approach for sinus augmentation procedures resulted in faster healing and sufficient torque values when implants were placed in areas with reduced bone height.13 Socket grafting: Many studies have evaluated the use of PRF after extraction as a socket membrane, sole socket filling material, or the addition to particulate socket grafting procedures. Most studies show positive healing effects when PRF is used in combination with socket graft procedures.14

Periodontal defects: The use of PRF in conjunction with periodontal and peri-implant disease procedures are well documented. Chang et al. reported that PRF is an effective modality in the treatment of infrabony periodontal defects.15 Hemostasis: PRF is an excellent hemostatic agent when used in procedures that may result in excess postoperative bleeding. PRF has been shown to exhibit very good antihemorrhagic properties, along with increased tissue healing, wound closure, and decreased postoperative pain. PRF membranes can be placed over the surgical site, or the surgical site can be lavaged with the material to decrease bleeding.16

Figure 14: PRF used as a membrane after implant placement.

Figure 15: PRF used as a membrane over a lateral wall sinus augmentation.

Figure 13: Fibrin clots placed in PRF box.

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CONCLUSION

Figure 16: PRF may be added to hydrate the graft material.

In the field of oral implantology, clinicians are always looking for ways to provide faster and more predictable hard- and soft-tissue healing. The most commonly used blood concentrate, platelet-rich fibrin, has been shown to be advantageous in a full array of implant procedures. Whether using PRF as a membrane or integrating it into the particulate bone graft, a favorable physiologic support system is achieved, which allows for an enhanced and more predictable healing process. This article has summarized a simple, clinically proven protocol for the use of blood concentrates for bone regeneration procedures that may be easily integrated into the general dentist’s practice. CM

REFERENCES

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1. Froum SJ, Wallace SS, Tarnow DP, Cho SC. Effect of platelet-rich plasma on bone growth and osseointegration in human maxillary sinus grafts: three bilateral case reports. Int J Periodontics Restorative Dent. 2002 Feb;22(1):45-53. 2. Alissa R, Esposito M, Horner K, Oliver R. The influence of platelet-rich plasma on the healing of extraction sockets: an explorative randomised clinical trial. Eur J Oral Implantol. 2010 Summer;3(2):121-34.

biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e45-50. 10. Kobayashi E, Flückiger L, Fujioka-Kobayashi M, Sawada K, Sculean A, Schaller B, Miron RJ. Comparative release of growth factors from PRP, PRF, and advanced-PRF. Clin Oral Investig. 2016 Dec;20(9):2353-60. 11. Montanari M, Callea M, Yavuz I, Maglione M. A new biological approach to guided bone and tissue regeneration. BMJ Case Rep. 2013 Apr 9;2013:bcr2012008240. 12. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Plateletrich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):299-303. 13. Diss A, Dohan DM, Mouhyi J, Mahler P. Osteotome sinus floor elevation using Choukroun’s platelet-rich fibrin as grafting material: a 1-year prospective pilot study with microthreaded implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 May;105(5):572-9. 14. Temmerman A, Vandessel J, Castro A, Jacobs R, Teughels W, Pinto N, Quirynen M. The use of leucocyte and platelet-rich fibrin in socket management and ridge preservation: a split-mouth, randomized, controlled clinical trial. J Clin Periodontol. 2016 Nov;43(11):990-9. 15. Chang YC, Zhao JH. Effects of platelet-rich fibrin on human periodontal ligament fibroblasts and application for periodontal infrabony defects. Aust Dental J. 2011 Dec;56(4):365-71. 16. Sammartino G, Dohan Ehrenfest DM, Carile F, Tia M, Bucci P. Prevention of hemorrhagic complications after dental extractions into open heart surgery patients under anticoagulant therapy: the use of leukocyte- and platelet-rich fibrin. J Oral Implantol. 2011 Dec;37(6):681-90.

3. Kiran NK, Mukunda KS, Tilak Raj TN. Platelet concentrates: a promising innovation in dentistry. J Dent Sci Res. 2011;2:50-61. 4. Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jun;85(6):638-46.

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Figures 17a, 17b: PRF may be used in conjunction with crestal-approach sinus augmentation procedures.

5. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a secondgeneration platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e51-5. 6. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, Dohan AJ, Mouhyi J, Dohan DM. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e56-60. 7. Kang YH, Jeon SH, Park JY, Chung JH, Choung YH, Choung HW, Kim ES, Choung PH. Platelet-rich fibrin is a bioscaffold and reservoir of growth factors for tissue regeneration. Tissue Eng Part A. 2011 Feb;17(3-4):349-59. 8. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a secondgeneration platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Mar;101(3):e37-44.

Figure 18: A membrane may be hydrated in PPP or PRF.

9. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin (PRF): a secondgeneration platelet concentrate. Part II: platelet-related

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EARN CE CREDIT Earn free CE credit for this article. Scan the code or go to glidewelldental.com/1501-ce to enter your answers.

QUESTIONS ON NEXT PAGE

Enhancing Bone Regeneration with the Use of Platelet Concentrates 1. Which of the following bone growth factors are released by platelet concentrates? a. Platelet-derived growth factor b. Transforming growth factor beta c. Insulin-like growth factor d. Epithelial growth factor e. All of the above

6. When performing a venipuncture, the needle should penetrate the tissue at a 40-degree angle to obtain the blood sample. a. True b. False

2. Platelet-rich plasma (PRP) is a first-generation blood concentrate that requires two centrifuge spins and was introduced by Dr. Robert Marx in 1998. a. True b. False 3. Platelet-rich fibrin (PRF) is a second-generation blood concentrate that requires only one centrifuge spin and was developed by Dr. Joseph Choukroun in 2001. a. True b. False 4. As a platelet degranulates, growth factors are released over what time period? a. 24 hours b. 48 hours c. 1â&#x20AC;&#x201C;4 weeks d. 6 months e. 1 year 5. Which of the following techniques may be utilized to help in identifying the location of a vein? a. Light tapping on the site b. Warm, moist towel c. Nitrous oxide d. Vein locator e. All of the above

by Randolph R. Resnik, DMD, MDS

7. In the single-spin centrifuge technique for PRF, the blood sample is spun at approximately 1,200â&#x20AC;&#x201C;1,500 rpm. a. True b. False 8. After centrifuge completion with the PRF technique, there will be three layers within the collection tube. The top layer consists of which end product? a. Acellular platelet-poor plasma (PPP) b. Platelet-rich fibrin (PRF) clot c. Sticky bone d. Red blood cells e. Buffy coat 9. After centrifuge completion with the PRF technique, which end product forms the middle layer of the collection tube? a. Acellular platelet-poor plasma (PPP) b. Platelet-rich fibrin (PRF) clot c. Sticky bone d. Red blood cells e. Thrombin 10. After centrifuge completion with the PRF technique, which end product forms the bottom layer of the collection tube? a. Acellular platelet-poor plasma (PPP) b. Platelet-rich fibrin (PRF) clot c. Sticky bone d. Red blood cells e. Thrombin

To receive free CE credit for this article, go to glidewelldental.com/1501-ce. Visit glidewelldental.com/education to access other free, on-demand CE courses. Or enroll in a hands-on course in a city near you. Register today!

Glidewell Education Center is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

The Glidewell Education Center is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or any other applicable regulatory authority, or AGD endorsement. The current term of approval extends from 3/1/2015 to 2/28/2021. Provider ID# 216789

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Dental Sleep Medicine: Should You Become a Medicare DME Supplier? by R andy Curran and Kyle Curran chairside@glidewelldental.com

ith roughly 10,000 baby boomers turning 65 each day,1 a sizable portion of the patient population may be receiving Medicare benefits. Are you considering becoming a Medicare DME (durable medical equipment) supplier? If so, what’s holding you back? Not sure that you will meet the enrollment requirements? Worried that you won’t receive adequate reimbursement? Whatever your situation, becoming a Medicare supplier is worth examining further, particularly if you’re considering expanding your patient demographic in dental sleep medicine.

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When it comes to important factors that can impact your dental practice, the option to become a Medicare DME supplier ranks high on that list. Before making this pivotal decision, it’s best to learn the facts of the matter. Medicare is a federally funded health insurance program that covers U.S. citizens aged 65 and older. As a federal program, it has strict guidelines, and healthcare providers must qualify to become a Medicare supplier in order to bill and receive reimbursement for services. The process is not as simple as sending in a few forms and receiving a certification in the mail. Rather, various requirements are involved throughout the application process, including fingerprint background checks and practice site inspections. Once you are credentialed, you have an obligation to fully understand and meet Medicare’s policies as listed in the following three Medicare documents: • Local Coverage Determination (LCD): Oral Appliances for Obstructive Sleep Apnea (L33611) • Local Coverage Article: Oral Appliances for Obstructive Sleep Apnea – Policy Article (A52512) • Local Coverage Article: Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426) These documents can be accessed through the Centers for Medicare & Medicaid Services at cms.gov. Read and become thoroughly familiar with the policies before you begin treating Medicare patients. For example, a summary of the LCD is illustrated to the right. Once you become familiar with all of the policies in the three Medicare documents, these policies will become quite routine. It’s important to note that these requirements

About 10,000 baby boomers turn 65 each day, which means a significant number of patients may be receiving Medicare benefits.

MEDICARE LOCAL COVERAGE DETERMINATION REQUIREMENTS INCLUDE THE FOLLOWING: • Documented face-to-face notes with the sleep physician prior to the patient’s sleep study. • Medicare-covered sleep study performed by a Medicare-accredited provider. • Detailed written order or Rx (dated after sleep study) must be on file and must include:

Patient name

Date of order

Description of item and quantity

§ Ask for the order to include the following description:

E0486 oral appliance to treat obstructive sleep apnea. Ideally, you should include the name of the appliance.

Ordering physician’s name

Ordering physician’s signature

Date of the signature

• Oral appliance must be Medicare Pricing, Data Analysis and Coding (PDAC) approved. • Proof of delivery must be signed by the patient.

nter an appliance description on the proof-of-delivery form, E demonstrating that the device is from the list of PDACapproved appliances.

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are well established; therefore, the sleep physicians you work with will already be familiar with them. Once you start treating Medicare patients on a consistent basis and are known as a supplier who accepts this type of insurance, the benefits will clearly present themselves.

PRACTICE BENEFITS

Itâ&#x20AC;&#x2122;s imperative that dentists are thoroughly familiar with Medicare policies before treating Medicare patients.

The fundamental benefit that will come to your practice is the expanded patient demographic. No longer will you have to present a cash option to every person aged 65 and older. You will be able to confidently inform them that you accept their insurance and that their out-of-pocket cost will be significantly less than it was before. Closed doors will open, and previously declined treatment will be accepted more often. You will also increase your market for a wider range of patients. Many of your Medicare patients will be extremely grateful that you accept their insurance and will recommend you to friends and family who need treatment for obstructive sleep apnea (OSA). The more people you accept, the faster your referral tree will grow. Another benefit is that busy sleep physicians will be an excellent source for referrals, as they seek additional solutions for patients who experience mild to moderate OSA or are CPAPintolerant. These physicians will likely be even more motivated to refer patients to you when they learn that you accept Medicare coverage. Given the amount of tasks sleep physicians have to process daily, itâ&#x20AC;&#x2122;s probable that they would most likely send their patients to a dentist they already know and have confidence in. Indeed, acceptance of Medicare patients can go a long way in solidifying your relationship with sleep physicians.

When dentists accept Medicare insurance, they may be more likely to receive referrals from sleep physicians who seek to provide more treatment options to patients.

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MEDICAL REIMBURSEMENTS Medicare claims and payments are topics that baffle many dentists, but

with a little experience, reimbursements can become more straightforward. Medicare reimburses differently depending on the state — some allow up to approximately $1,950, while others allow as low as around $1,100. Even dentists in lower-paying states have the opportunity to treat Medicare patients while remaining profitable by understanding how Medicare pays. When applying to become a Medicare supplier, choose to enroll as a nonparticipating supplier. This choice allows you to accept assignment or to not accept assignment on a case-by-case basis. Let’s examine sample scenarios for accepting assignment or not accepting assignment.

CASE EXAMPLE 1: ACCEPTING ASSIGNMENT Accepting assignment means that you will accept what Medicare allows as payment in full and that you cannot charge the patient any additional amount. For example, in the state of New York: • Medicare allows payment of approximately $1,950. • The patient’s deductible of $185 remains along with the 20% coinsurance. • After those are deducted, Medicare pays $1,410 and the patient’s out-of-pocket cost is $538.

CASE EXAMPLE 2: NOT ACCEPTING ASSIGNMENT Not accepting assignment means that you can keep your current fee schedule. The patient will be reimbursed the

As nonparticipating suppliers, dentists can choose to accept or not accept assignment on a case-by-case basis.

Medicare-allowable amount within the state. For example, in the state of Texas: • The dentist collects $2,000 up front from the patient during the visit for impressions to be taken. • Medicare allows payment of approximately $1,150. • The patient’s deductible of $185 remains along with the 20% coinsurance. • After those are deducted, Medicare reimburses the patient $772 in 6–8 weeks after delivery. Remember, as a nonparticipating supplier, you can choose to accept or not accept assignment on a case-by-case basis. Also, on an unassigned claim, some supplemental insurance plans will pay the entire balance charged

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for the appliance and the amount Medicare allows.

CONCLUSION When making your decision about becoming a Medicare DME supplier, consider the benefits listed throughout this article, including an expanded patient demographic, increased referrals, better relationships with sleep physicians, enhanced credibility and reliable payments. Above all else, consider that you will be helping 65-and-over patients receive the care they need to gain a better quality of life. CM

REFERENCE 1. Pew Research Center [internet]. Washington, D.C.: Pew Research Center; c2019. Baby boomers retire; 2010 Dec 29 [cited 2019 Dec 5]. Available from: https://www.pewresearch.org/facttank/2010/12/29/baby-boomers-retire/.

EDUCATION CORNER

Sharing Knowledge —

Making a Difference

Dr. Taylor Manalili (left) and Dr. Justin Chi (right) received their fellowships at the ICOI World Congress 2019, held in New York City. They are joined by Dr. Neil Park, who is a Diplomate of the prestigious implant society.

ICOI WELCOMES TWO TALENTED NEW MEMBERS The International Congress of Oral Implantologists (ICOI) recently presented fellowship awards to Drs. Taylor Manalili and Justin Chi, for their demonstration of exceptional interest and knowledge in the advancement of implant dentistry. The ICOI, founded in 1932, is the world’s largest dental implant organization, recognizing achievements in the field of oral implantology while supporting clinical research and continuing education. “Becoming an ICOI Fellow recognizes our study and clinical accomplishments in the field. It is a great honor to be recognized,” said Dr. Chi. “I appreciate ICOI’s solid commitment to providing a high-quality educational platform for implantology, and I’m looking forward to being a part of this prestigious program,” Dr. Manalili added.

As Fellows of the ICOI, Drs. Chi and Manilili can expect to contribute and gain valuable insights into the exciting upcoming world of implant dentistry. Dr. Chi is director of clinical technologies at Glidewell. He joined Glidewell as a clinical research associate in 2015 after graduating from the Herman Ostrow School of Dentistry of USC. Dr. Manalili joined Glidewell in August 2018 as the first-ever Glidewell Fellow. Since that time, she has conducted clinical research and performed advanced restorative work, including implant placement, chairside restorations and fullmouth rehabilitations. Drs. Chi and Manalili join Dr. Neil Park, vice president of clinical affairs at Glidewell, who received his Diplomate status in the organization in 2017.

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UPCOMING DATES FOR THIS COURSE • May 29–30, 2020 (Louisville, Kentucky) Glidewell Clinical Education Training Center 3841 Business Park Drive Louisville, KY 40213 • Nov 20–21, 2020 (Irvine, California) Glidewell Clinical Education Training Center 18551 Von Karman Ave. Irvine, CA 92612 Times: 8:30 a.m.–4:30 p.m. (Day 1) 8:30 a.m.–2:30 p.m. (Day 2) Tuition: $1,295 per doctor + $295 per staff member

Dr. Charles Schlesinger assists a clinician during the hands-on lab portion of his course on hard-tissue grafting.

Available CE: 12 Hours

DR. CHARLES SCHLESINGER PRESENTS HANDS-ON PIG JAW COURSE FOR HARD-TISSUE GRAFTING

Method: Hands-On/Lecture/Participation

In May 2019, Glidewell Clinical Education introduced its “Hard Tissue Grafting: Hands-On Pig Jaw” course, taught by Dr. Charles Schlesinger, covering everything from the basics of grafting materials, to the surgical techniques proven effective for sinus elevations, ridge augmentation and grafting around immediate implants. This comprehensive course, which has steadily gained in popularity since its introduction, took place at the Glidewell Clinical Education training center in Louisville, Kentucky. The concepts taught were reinforced with a surgical, hands-on experience in a pig-jaw lab on the second day of the course. Attendees gained an understanding of the various regenerative materials used in grafting and learned when to utilize each, as well as the role of bone augmentation in placing and preparing sites for implants.

Visit glidewellcecenter.com to register.

Inspired by a passion for improving lives through oral health, Glidewell Clinical Education provides contemporary continuing education for dental professionals. Programs cover all aspects of modern implant and restorative dentistry, with hands-on courses and in-depth lectures carefully crafted to help you become more confident and successful in your practice.

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EDUCATION CORNER

UPCOMING DATES FOR THIS COURSE • May 2, 2020 (Irvine, California) Glidewell Clinical Education Training Center 18551 Von Karman Ave. Irvine, CA 92612 • Aug. 8, 2020 (Louisville, Kentucky) Glidewell Clinical Education Training Center 3841 Business Park Drive Louisville, KY 40213 Time: 8:30 a.m.–4:30 p.m. Tuition: $395 per doctor + $45 per staff member Available CE: 7 Hours Method: Hands-On/Lecture/Participation

Dr. Paresh Patel’s dental photography course equips dentists with the tools and techniques they need to capture effective images for patient education, marketing their dental practices, communicating with the lab, and more.

JUMPING INTO DENTAL PHOTOGRAPHY In September 2019, Dr. Paresh Patel presented a course at the Glidewell Clinical Education training center in Irvine, California, that provided the photographic fundamentals for capturing cases, from pre-op through final results. The course, “The Art of Photography,” equipped clinicians and their teams with valuable information for capturing clinical images that afford patients an increased sense of value and a fuller understanding of their treatment. In this interactive, hands-on program, attendees learned how to produce the highest-quality case photos possible.

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Visit glidewellcecenter.com to register.

ANNOUNCING THE GLIDEWELL EDUCATIONAL ADVISORY PANEL Glidewell is proud to announce the inception of the 2020 Glidewell Educational Advisory Panel. This board will consist of three highly regarded members of the dental community. Their purpose will be to advise the education team at Glidewell regarding what courses will be most valuable to practicing dentists. The panel will make suggestions as to what changes should be implemented in the future and will provide instrumental information through their knowledge, guidance and experience.

Dr. David Hochberg Dr. David Hochberg is an alumnus of the Emory University School of Dentistry and is past president of the American Academy of Implant Dentistry (AAID). He is a Diplomate of the American Board of Oral Implantology (ABOI). Dr. Hochberg operates a general practice in Atlanta that has provided restorative, implant and cosmetic dentistry services for more than 30 years.

Dr. Christopher Pallotto

Dr. Christopher Walinski

Dr. Christopher Pallotto received his DDS from the University of Illinois at Chicago College of Dentistry. Shortly after graduating, Dr. Pallotto began a distinguished career in the dental implant industry, where he worked in areas ranging from sales and marketing to research & development. In 2007, Dr. Pallotto returned to private practice at Oak Dental Associates in Illinois.

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Dr. Christopher Walinski is an associate professor of dental medicine, a course director for lasers in dentistry, and a clinical practice leader at Touro Dental Health at New York Medical College. He is the executive director of the World Clinical Laser Institute, and is a founding member of the American Academy of Oral Systemic Health. He is a Diplomate and past president of the World Congress of Minimally Invasive Dentistry and is past editor-in-chief of the Journal of Laser-Assisted Dentistry. CM

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PRODUCT SPOTLIGHT

OASYS Hinge Appliance™

octors now have a new treatment option for their patients who suffer from snoring or mild to moderate obstructive sleep apnea (OSA). The OASYS Hinge Appliance™ is a mandibular advancement device designed for maximum comfort. It utilizes micro-adjustable, telescope-style hinges that position the jaw forward during sleep, which opens the airway to allow proper airflow. Considering that about half of adults in the U.S. report that they snore,1 and approximately 80% of OSA cases are undiagnosed,2 dentists have an incredible opportunity to help patients who may not be aware of dental treatments for their snoring or sleep apnea. “The OASYS Hinge Appliance is instrumental for all dentists who treat sleep-disordered breathing,” said Dr. Taylor Manalili, clinical researcher and prosthodontist at Glidewell. “Because of the telescope-style hinge design

and a custom fit that allows natural movement, patients find it to be a very comfortable solution for OSA.” Dentists can additionally expand their reach to Medicare recipients. Because the OASYS Hinge Appliance is eligible for Medicare reimbursement under code E0486, these patients may be more receptive to a treatment plan, knowing that the appliance may be covered. The OASYS Hinge Appliance helps mitigate serious health risks associated with OSA, including heart attack, high blood pressure, obesity, stroke and diabetes, and helps patients get a better night’s sleep so they can feel more energy the next day. Visit glidewelldental.com/oasys or call 800-757-4428 to learn more or get help with starting your first case.

OSA is a serious condition that can lead to critical medical consequences. By screening patients regularly and making appropriate medical referrals, dentists have the power to positively transform lives.

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NEWPORT SURGICAL™ IMPLANT AND BONE GRAFTING INSTRUMENT KIT Developed in collaboration with top surgical professionals and implant educators, the Newport Surgical™ Implant and Bone Grafting Instrument Kit (Glidewell Direct; Irvine, Calif.) includes the essential instruments needed to complete bone grafting procedures typically performed in the general practice. Instead of being overwhelmed with kits that contain an excessive number of instruments or having to purchase several different kits to obtain all of the necessary instrumentation, dentists can now turn to one simple solution. Featuring top-quality German stainless steel, the Newport Surgical instrument kit includes the following:

1. Large Sterilization Tray 2. Bone Carrier and Spoon 3. 2/4 Molt Curette 4. Sinus Curette 5. Serrated Curette 6. Adson Forceps with Serrated Tips 7. Crile Needle Holder 8. Goldman-Fox One-Blade Serrated Scissors 9. Scalpel Handle No. 3 Round 10. Seldin Retractor 11. Oringer Mouth Retractor 12. Bone Dish

List price: $650

The kit provides premium instruments for the dentist’s armamentarium at an exceptional value and with a five-year warranty. In addition, the kit complements the Newport Surgical line of FDA-cleared and naturally sourced regenerative materials, which is available for the most common bone grafting procedures. The versatile collection of high-quality

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materials includes resorbable collagen membranes, resorbable collagen plugs, bone graft putty, and a mineralized cortico/cancellous allograft blend. Now, Newport Surgical is meeting the needs of general dentists who want the same convenience for the associated instrumentation. Visit glidewelldirect.com or call 800-757-4428 to place an order.

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PRODUCT SPOTLIGHT

RELI® SUTURES RELI® sutures are available in polyglycolic acid (REDISORB® PRO) and chromic gut (REDIGUT® CHROMIC PRO) with a 3/8 reverse cutting needle. The easy-retrieval RELI packaging allows for quick and simple access, so that surgeons can

rely on a dependable suture, without knots or tangles. Go to glidewelldirect.com or call 800-757-4428 to place an order and learn more about RELI sutures.

List price: $44.95 (12-pack)

List price: $32.95 (12-pack)

GLASSVAN® SURGICAL BLADES GLASSVAN® Surgical Blades feature newly refined cutting edges that improve the sharpness of the incision and reduce drag. Available in size #15, they are produced from high-quality Swiss carbon steel, which holds its edge longer than stainless steel. The automated grinding and polishing process during manufacturing results in consistently sharp edges. To ensure that tearing does not occur during deliv-

ery or storage, the blades are set in two vapor corrosion inhibitor (VCI) strips to avoid piercing of the foil packaging. Experience a sharper, more precise incision with GLASSVAN Surgical Blades. To place an order or learn more about how GLASSVAN Surgical Blades can improve dental procedures, visit glidewelldirect.com or call 800-757-4428.

List price: $19.95 (100-pack)

REFERENCES 1. Centers for Disease Control and Prevention (CDC). Unhealthy sleep-related behaviors—12 States, 2009. MMWR Morb Mortal Wkly Rep. 2011 Mar 4;60(8):233-8. 2. Sleep apnea information for clinicians [internet]. Washington, D.C.: American Sleep Apnea Association; c2019 [cited 2019 Nov 21]. Available from: https://www.sleepapnea.org/learn/sleepapnea-information-clinicians. OASYS Hinge Appliance is a trademark of Dream Systems LLC. RELI, REDISORB, REDIGUT and GLASSVAN are registered trademarks of Myco Medical Supplies, Inc.

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EXPERIENCE THE DIFFERENCE IN Esthetic Dentistry Crown & Bridge Master Class: Methods and Materials for Restorative Success Michael DiTolla, DDS, FAGD

Available CE 7

Tuition $595 per Doctor + $195 per Staff Member

Dates Feb. 28, 2020 — Elizabeth, NJ March 20, 2020 — Philadelphia, PA May 22, 2020 — Washington, DC Oct. 9, 2020 — Chicago, IL

Esthetic Dentistry in the Real World Steven Barrett, DDS

Available CE 7

Tuition $595 per Doctor + $195 per Staff Member

Dates

May 22, 2020 — Irvine, CA Aug. 21, 2020 — Louisville, KY Oct. 30, 2020 — Irvine, CA

Dental Sleep Medicine Incorporating Dental Sleep Medicine Into Your Practice Suzanne Haley, DMD

Available CE 13

Tuition $795 per Doctor + $295 per Staff Member

Dates Feb. 28–29, 2020 — Irvine, CA Aug. 28–29, 2020 — Louisville, KY Dec. 4–5, 2020 — Charlotte, NC

Dental Sleep Medicine: Overcoming the Challenges to Successful Implementation John Tucker, DMD, DABDSM, DICOI

Available CE 16

Tuition $795 per Doctor + $295 per Staff Member

Dates April 17–18, 2020 — Louisville, KY Nov. 13–14, 2020 — Louisville, KY

Treating the Not-So-Silent Killer: Protecting Patients with Sleep-Disordered Breathing Ken Berley, DDS, J.D., DABDSM, FAGD

Available CE 13

Tuition $795 per Doctor + $295 per Staff Member

Dates June 26–27, 2020 — Irvine, CA Sept. 18–19, 2020 — Irvine, CA

DENTAL CONTINUING EDUCATION Implants Surgical Surgical Placement of Dental Implants: A Restorative-Driven Approach Timothy Kosinski, DDS, MAGD

Available CE 13

Tuition $1,895 per Doctor + $395 per Staff Member

Dates April 24–25, 2020 — Louisville, KY July 31–Aug. 1, 2020 — Irvine, CA

Hard Tissue Grafting: Hands-On Pig Jaw Course Charles Schlesinger, DDS, FICOI

Available CE 12

Tuition $1,295 per Doctor + $295 per Staff Member

Dates May 29–30, 2020 — Louisville, KY Nov. 20–21, 2020 — Irvine, CA

Implants and Restorative Dentistry: Strategies for the Older Patient Raymond Choi, DDS

Available CE 13

Tuition $995 per Doctor + $395 per Staff Member

Dates June 12–13, 2020 — Irvine, CA Oct. 30–31, 2020 — Louisville, KY

Implants Restorative Full-Arch Implant Solutions from Overdentures to Fixed Ceramics Paresh B. Patel, DDS

Available CE 13

Tuition $1,295 per Doctor + $295 per Staff Member

Dates March 6–7, 2020 — Irvine, CA July 24–25, 2020 — Elizabeth, NJ Oct. 16–17, 2020 — Louisville, KY Dec. 4–5, 2020 — Louisville, KY

The Restoration of Dental Implants — A Comprehensive Review of Materials and Techniques Taylor Manalili, DDS, FICOI

Available CE 12

Tuition $995 per Doctor + $395 per Staff Member

Dates April 3–4, 2020 — Louisville, KY Sept. 11–12, 2020 — Irvine, CA

Visit the website for a complete list of our 2020 courses!

866-791-9539 ❘ glidewellcecenter.com GL-1390504-120619

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EDUCATION CORNER

Glidewell Presents Free Online CE Courses Interview with Susmitha Valvekar, Program Manager of Online Training at Glidewell chairside@glidewelldental.com

With the recent launch of education.glidewelldental.com, Glidewell has made it even easier for dental professionals to find the continuing education (CE) courses they seek. In this interview, Susmitha Valvekar, program manager of online training at Glidewell, discusses what differentiates the new site from Glidewell’s previous educational content, along with how Glidewell uses participants’ feedback to create and improve its online education resources. CHAIRSIDE® MAGAZINE:With established resources such as Glidewell Clinical Education training centers and the Glidewell Symposium, Glidewell offers a significant number of live CE opportunities. What prompted the company to launch a new education site offering ondemand CE courses? SUSMITHA VALVEKAR: Busy doctors are looking for courses that they can more easily access and finish at their own pace. We’ve had online learning resources in the form of YouTube videos and courses on learning platforms, but they were not well curated or well organized for the learner. With my background in learning and development, I began thinking of various

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Glidewell’s new education site is designed as an accurate and reliable learning platform for dental professionals, according to Susmitha Valvekar, program manager of online training.

questions while working on the new site: What are the learners’ needs? What are doctors asking us for? Which topics on our website are getting the most views? The statistics showed us that quite a few people were turning to us for education resources, but we needed to make those resources easier to access. CM: What makes this new education site different from other continuing education sources, including the ondemand CE courses that have been available on Glidewell’s website for a number of years? SV: The most immediate advantage of this new site compared to our previous online CE course structure is that we are able to more responsively tap into participants’ needs. Not only have we included a star-rating system so that course participants can provide instant feedback, but we’re also reaching out to doctors and asking them what courses they’re looking for — and then using that feedback to create courses. CM: How will the new site make accessing CE easier for clinicians and other dental professionals? SV: On the new site, only a single login is required, so existing customers who already have a Glidewell account

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Susmitha’s vision for the new website emphasizes tailoring online CE content in response to user feedback, so that clinicians have access to courses that are as relevant to their practices as possible.

can instantly access the content. And if you’re not a customer, and you’re looking for a particular CE course, we’ve worked to improve the keyword and category searchability of the new site. We want all courses to be easy to find and located in one portal.

clinical content, we’ve added topics that are more reflective of our time, such as how to reach out to millennial patients, and we’re even going to have a couple of doctors come in to discuss how to integrate mindfulness into the dental practice.

CM: How have the CE courses on the new site been developed?

CM: What have you found are Glidewell’s most popular online CE subjects and courses?

SV: We’ve created new courses based on feedback from dental professionals. That incorporation of feedback from people who are actually out in the field is the biggest difference. In addition to

The most immediate advantage of this new site compared to our previous online CE course structure is that we are able to more responsively tap into participants’ needs ... We’ve created new courses based on feedback from dental professionals.

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SV: Implantology is the most popular subject, though crown & bridge is catching up. We’ve also seen significant interest in esthetic dentistry, dentures and dental sleep medicine. CM: What are Glidewell’s future plans on the online CE front? Will Glidewell be offering more CE resources both online and offline? SV: We want our online and live education branches to work together. If an online CE course has a lot of hits — for instance, something related to implants — and we know people are very interested in learning more about it, we’ll make sure that topic is covered in a live course that will allow participants to get hands-on experience. In the online sphere, we want to have more interactive courses — in fact, we’ve been developing an online study

EDUCATION CORNER club. Through this study club, people will be able to ask questions and interact with instructors in a way that isn’t possible in other online courses. We’re looking to host webinars with a question-and-answer forum for

course participants — clinicians can ask the instructor questions at any time, and the instructor will be able to respond to all of those questions. We want to give the participants a more interactive, hands-on experience.

We’ve also started producing webinars and training videos for dental assistants and other office staff members. These videos provide step-by-step guidance for dental staff so that they are as comfortable and efficient as possible when they’re working with the doctor. For example, one of these training videos is about implant surgery setup and addresses several key questions: How do you lay out the surgery tools for the doctor? What are the protocols you need to set up for the doctor before this type of surgery, and how would you assist the doctor with that? Ultimately, our goal is to create learning platforms for dental professionals that are accessible as well as reliable, while ensuring that our courses provide participants with tools that they can immediately use in their practices. CM

Users’ ability to find and provide feedback about online education resources is one of the advantages of the new education site.

Glidewell plans to produce interactive courses that will allow participants to communicate in real time with clinician instructors.

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CROWN & BRIDGE Cementation: Tips, Tricks and Trends for Success by Chad Duplantis, DDS Restorative Materials: An Update by Mayuri Kerr, BDS, M.S. Crown & Bridge: Clinical Tips for Success by Michael DiTolla, DDS, FAGD Shade Selection by Michael DiTolla, DDS, FAGD Local Anesthesia Strategies by Michael DiTolla, DDS, FAGD Material Selection for Crown & Bridge by Michael DiTolla, DDS, FAGD

Surgical Pathways for Implant Dentistry: How to Be Affordable and Profitable by Timothy F. Kosinski, DDS, MAGD The Emergency Implant: Extraction and Immediate Replacement by Jack Hahn, DDS Ridge Preservation: Protocol for Success by Charles Schlesinger, DDS, FICOI Extraction and Socket Grafting: Part 1 — Atraumatic Extraction by Randolph R. Resnik, DMD, MDS Extraction and Socket Grafting: Part 2 — Extraction Site Healing by Randolph R. Resnik, DMD, MDS Extraction and Socket Grafting: Part 3 — Socket Grafting Protocol by Randolph R. Resnik, DMD, MDS

IMPLANTS

ESTHETIC DENTISTRY

Full-Arch Implant Placement: The Healed Ridge by Paresh B. Patel, DDS

Esthetic Dentistry by Justin Chi, DDS, CDT

Fully Guided Implant Placement by Paresh B. Patel, DDS Atraumatic Extraction and Socket Grafting by Paresh B. Patel, DDS

Veneer Prep School: Strategies for Choosing an Ideal Prep by Anamaria Muresan, DMD, ME, CDT CBCT Guided Surgery by Charles Schlesinger, DDS, FICOI

Free Impactful On-Demand CE Courses Earn FREE CE credit at a time that’s most convenient for you. Learn everything from clinical techniques to practice management. For our full collection, visit education.glidewelldental.com. DIGITAL DENTISTRY Clinical Success with CAD/CAM Restorations by Justin Chi, DDS, CDT REMOVABLE Complete Dentures: Clinical Procedures IMPLANTS PROSTHETICS Principles of Implant Occlusion: Part 1 — Implants Are Not Teeth by Randolph R. Resnik, DMD, MDS Principles of Implant Occlusion: Part 2 — Recommendations for Single Implant Prostheses by Randolph R. Resnik, DMD, MDS Principles of Implant Occlusion: Part 3 — Recommendations for Fixed Full-Arch Implant Prostheses by Randolph R. Resnik, DMD, MDS Principles of Implant Occlusion: Part 4 — Recommendations for Removable Implant Prostheses by Randolph R. Resnik, DMD, MDS Removable and Fixed Solutions for the Edentulous Patient by Paresh B. Patel, DDS 800-854-7256 • education.glidewelldental.com

Clinical Tip: The “Book” Approach to Reflecting a Surgical Flap by Jack Hahn, DDS Success Factors for Immediate Implant Placement in the Anterior by Paresh B. Patel, DDS Digitally Guided Implant Placement by Taylor Manalili, DDS, FICOI DENTAL SLEEP MEDICINE Incorporating Dental Sleep Medicine Into Your Practice by Suzanne R. Mericle, DMD PRACTICE MANAGEMENT New Technology: Disruption or Increased Production? by Carrie Webber Millennial Dentistry by Chad Duplantis, DDS ELECTIVES Dental Photography by Paresh B. Patel, DDS

LEADIN G

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LASTING

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L O VED

BruxZir® Celebrates 10 Years Strong

n 2009, Glidewell launched BruxZir® Solid Zirconia with one driving desire: to offer clinicians a high-strength, tooth-colored crown for indications that had been traditionally treated with PFMs or cast gold restorations. While zirconia had started building some popularity as a substructure material for porcelain fused to zirconia restorations, the use of solid zirconia as a full-contour option for creating an entire crown was practically unknown. Even though Glidewell had tremendous confidence in BruxZir Solid Zirconia, it did not anticipate that this revolutionary brand would evolve to the point where it is today. Fast-forward a decade, and now BruxZir Solid Zirconia has surpassed its initial, simple objective. Not only has it become the No. 1 brand of monolithic zirconia used in the world, but it has also spearheaded a monolithic revolution that’s seen the dental field move in a new direction, where all-ceramics are used for virtually all indications. Reaching this historic milestone is a testament to the clinicians BruxZir zirconia was designed to serve. So far, the zirconia material has been utilized to create more than 20 million beautiful smiles. One of which is Maria Jackson’s, a patient whose life was completely transformed. Maria went from being self-conscious to proudly sharing her smile after receiving her BruxZir Esthetic bridge. Maria recalled, “It was traumatic, embarrassing, and, at times painful to talk or interact with people because I was worrying about my teeth.” But today, she has a different story to tell. “Now, I smile beautifully with confidence,” said Maria. In marking the 10th anniversary of BruxZir Solid Zirconia, Glidewell celebrated by thanking dental practitioners for a decade of trust, and for making BruxZir zirconia the leading, last-

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Dr. Joel De Souza of Olde Oakville Dental in Ontario, Canada, holding a BruxZir NOW crown, which he milled with the glidewell.io™ In-Office Solution to deliver a same-visit restoration.

ing and loved brand of today. After all, it was the relentless drive of dentists to provide patients with better results that inspired the creation of BruxZir zirconia, and that drive continues to push future innovation. Originally, the Glidewell Research & Development team created BruxZir Solid Zirconia for dentists to use in the posterior due to its fracture-resistant nature. Clinicians not only quickly embraced it, but also began utilizing it for indications far beyond its original scope. Therefore, the R&D team responded. Now BruxZir Solid Zirconia can be prescribed anywhere in the mouth as crowns & bridges, screw-retained restorations and full-arch implant prostheses. And it is available in two distinct formulations: BruxZir FullStrength and the new BruxZir Esthetic that launched in 2018. Glidewell’s researchers engineered BruxZir FullStrength to withstand the toughest oral challenges, and they developed BruxZir Esthetic to provide clinicians a material that has an optimized

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After suffering a fractured tooth, Maria Jackson had her smile beautifully restored utilizing BruxZir Esthetic Solid Zirconia.

Bobbie Norton is another patient whose life was changed after receiving a BruxZir Esthetic smile makeover. “I absolutely love the way my smile looks now. I have more confidence and I can’t stop smiling,” said Bobbie.

combination of strength and lifelike translucency for the anterior. Over the past decade, practicing clinicians and product evaluators have responded by giving top marks to this family of materials. In August 2019, the Clinicians Report®, an independent publication, described BruxZir Solid Zirconia as “the most successful tooth-colored restoration in the history of dentistry.”1 Clinicians Report also recognized BruxZir Full-Strength as “Best in Class” after an 8-year study revealed zero terminal factures, 100% survival and minimal wear on opposing dentition.2 Humbled by the widespread trust that BruxZir zirconia has earned, Glidewell remains committed to providing dentists and patients alike with leading validation, lasting performance and loved results in the coming decade. CM

REFERENCES 1. An independent, nonprofit, dental education and product testing foundation, Clinicians Report®, August 2019. For the full report, go to bruxzir.com/most-successful.

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Clinicians Report®, an independent publication, has researched BruxZir Solid Zirconia for over nine years, making it the most clinically validated zirconia in dentistry.

2. An independent, nonprofit, dental education and product testing foundation, Clinicians Report®, November 2018. For the full report, go to bruxzir.com/8-year. Study results apply to BruxZir 2009 3Y zirconia.

EMPLOYEE SPOTLIGHT

ui Luu-Verstegen got her start in dentistry as a sterilization technician more than 20 years ago while still in high school. Her growing enthusiasm for dentistry led her to apply for a technical advisor position at Glidewell. She jumped at the chance to see the dental field from the laboratory side and help doctors get the restoration that their patients needed. Mui is working toward becoming a Certified Dental Technician and, as an advisor in Glidewellâ&#x20AC;&#x2122;s Digital Treatment Planning department, she also helps doctors plan their implant cases.

Digital Treatment Process Advisor

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CHAIRSIDE ® MAGAZINE: You’ve been with Glidewell for eight years. How has your experience been moving from a technical advisor to our Digital Treatment Planning department? MUI LUU-VERSTEGEN: When I first started at Glidewell, my main goal was just to help doctors as much as I could. I wanted every doctor I spoke with to have an amazing experience. As I continued learning about our company, customers and technology, I was blown away by how much opportunity there is here to learn and grow in the dental profession. Digital Treatment Planning is such a special place to work. The surgical guides that we create for dentists help them achieve the exact implant positioning needed for a safe and predictable outcome. So it’s great to be involved in that. CM: Can you walk us through the process of how a digital treatment planning case gets started? MLV: The first step is that the doctor would call us to initiate the case. We absolutely need to have the CT scan in order to treatment plan the case. We’ll also want to learn how we’re getting the information about the patient’s oral situation. Is the doctor sending in a full-arch VPS impression or did they use an intraoral scanner? If it’s an intraoral scan, the doctor can just upload the files, along with the CT scan files, to the Digital Treatment Planning portal using the My Account feature on glidewelldental.com. For a physical impression, they’ll just mail it to the Digital Treatment Planning department. CM: From there, what does the experience look like for the doctor? MLV: It’s a highly customized and personal experience for the doctor. As their digital treatment process advisor, I work with the doctors at each point

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in the process from start to finish. If there are any issues after they send in the case, or if they want to change their treatment plan, I will work with them on that and assist them in any way they need. CM: It sounds like you are intimately involved at every stage of the case. MLV: Correct. We work very closely with all our doctors, whether they’re placing their first implant or they’ve been placing them for years. Most doctors don’t realize that the Digital Treatment Planning department is sort of like its own little lab. I do everything on their cases. I merge the data from the doctor if they send in a scan, or if it’s a physical impression, then I’ll scan the model and design the case digitally. I treatment plan the case and send the surgical report to the doctor for approval. Once the doctor approves, we generate the digital file used to fabricate the surgical guide.

of time what’s going to happen. And for the patient, it’s less invasive and so much more efficient. CM: Could you tell us how digital treatment planning saves the doctor chair time? MLV: With a digital treatment plan, we eliminate a majority of the questions that the doctor would usually have to work through. We give you the implant length, the drilling sequence and the angulation. The digital treatment plan accounts for the location of all the critical anatomical structures. All of this just speeds up the process and makes it easier on doctors and their patients. CM: And can your Digital Treatment Planning department offer this for any implant system?

CM: How does digital treatment planning help the doctor and the patient?

MLV: We support virtually all major implant systems on the market. But if doctors use the Hahn™ Tapered Implant System, they’ll get a 20% discount off their final restoration.

MLV: There are lots of benefits to placing implants through a digitally fabricated surgical guide. It’s more predictable because you can capture and use more anatomical information than you would with a traditional workflow. So the doctor knows ahead

Pictured Above: Mui Luu-Verstegen inserting a titanium sleeve into a surgical guide produced by the Digital Treatment Planning department. Helping dentists provide a procedure that is both safe and efficient for their patients is one of the aspects Mui enjoys most about her job.

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EMPLOYEE SPOTLIGHT Not only is Hahn a great system, but they’ll also have the opportunity to get the Hahn Bundle — which includes the surgical guide, implant, healing abutment, and either the impression coping or scan body — for a price that significantly reduces the cost of this type of treatment. CM: What turnaround time can doctors expect with the digital treatment planning workflow? MLV: Usually, we can do the treatment plan and print the surgical guide in three to five days. If the production floor is particularly busy, it can take up to eight days to treatment plan and then five days to print the surgical guide. But we’ll always let the doctor know that ahead of time. CM: How have doctors responded to the experience they get with digital treatment planning? MLV: The doctors love the personal and hands-on treatment they get from their digital treatment process advisors. We offer them a step-bystep process for placing their implants successfully, with access to all of the amazing technology that Glidewell has invested in and developed. CM: When you’re not helping doctors, what do you enjoy doing in your free time? MLV: I love spending time with my two daughters. We love baking together and making goodies like brownies, cupcakes or cookies. But my specialty is my banana pudding. Sometimes I’ll make some and bring it in for my team members, which they love. CM: Thank you for your time, Mui. We loved hearing about your passion for our doctors and their patients. MLV: My pleasure. CM

Top: Mui works with dentists to create digital treatment plans and design surgical guides that help position the implant in the precise location needed for a predictable and esthetic outcome. The Digital Treatment Planning department uses advanced 3D software to digitally determine the optimal implant position for guided surgery cases. Here, Mui is standing in front of the 3D printers used to fabricate surgical guides based on digital treatment plans she develops in collaboration with dentists. Bottom: Mui with her husband and two daughters, with whom she shares a passion for baking.

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NOVEMBER 6â&#x20AC;&#x201C;7 Anaheim Convention Center Anaheim, Calif.

KEYNOTE SPEAKERS: Gordon J. Christensen, DDS, MSD, Ph.D. Jack Hahn, DDS

$275 EARLY BIRD $325 reg price

GL-1390503-120619

Chairside Magazine Volume 15, Issue 1

Articles inside

Employee Spotlight: Mui Luu-Verstegen

BruxZir® Celebrates 10 Years Strong

Education Corner: Glidewell Presents Free Online CE Courses

Product Spotlight: OASYS Hinge Appliance™

Education Corner: Sharing Knowledge — Making a Difference

Dental Sleep Medicine: Should You Become a Medicare DME Supplier?

Enhancing Bone Regeneration with the Use of Platelet Concentrates

An Inside Look at Implant Dentistry’s Essential Textbook

Interview with Stephenie Goddard: An Inside Look at the Guiding Leaders Summit 2020

My Transformational Journey as a Guiding Leader

New Technology: Practice Disruption or Increased Production?

R&D Corner: Utilizing AI to Produce Better Crowns, Faster

Common Problems with Digital Impressions — and How to Avoid Them

Why Every Dentist Must Screen for Sleep-Related Breathing Disorders

Implant Surgery: When Should You Use a Flapless Technique?

My First 60 Days: A glidewell.io™ Practice Report

My First Implant: My First ‘Emergency’ Implant

Glidewell Dental Symposium 2019: Answers to Audience Questions

Third Annual Glidewell Dental Symposium: A Weekend of Clinical Education

Smiling from the Inside Out: Restoring a Smile After an Eating Disorder

Contributors

Letter to the Editor

By the Numbers

Editor's Letter

Publisher's Letter