Dental Arabia Middle East Magazine by Z-Systems Ceramic Dental Implants

International Academy of

Ceramic Implantology

I S S U E

0 3

20 14 Volume 04

Winter Congress 2015 (Page. 19)

DOUBLE TAKE

“You need to check it out and add to your short list”...

COVER STORY

CERAMIC IMPLANTS

It may take a lot to “wow” DPR’s technology evangelist, but this curing light from Kerr definitely caught his attention.

INSIDE LOOK

A close l llook k att CBCT and its ROI benefits Once you make your high-tech purchase, how do you know you’re getting the most “bang for your buck?” One dentist shares his thoughts.

DOUBLE TAKE

“The delivery system is easy to clean, adaptive to patient and provider.”

HOW TO

Simplify the direct restorative process Using a universal adhesive with multiple composite resins from Ivoclar Vivadent for great clinical results.

One clinician’s view of the A-dec 500 Chair System with the EA-52 LED electric motor handpiece.

TECHNIQUE TECH BRIEF

Remove gingival pigmentation with a diode laser

Applying Sapphire Plus in your practice Sapphire Plus generates and delivers maximum curing and whitening power to the restoration with the new Power Conversion Technology.

A clinical case the illustrates the use of a digitally pulsed high power diode laser with minimal anaesthesia for gingival de-pigmentation.

TECH BRIEF

Applying SmartLite tLite Focus in your practice

Applying Planmeca PlanScan in your practice

A closer look at this new pen-style LED curing light.

A closer look at this ultra-fast intraoral scanner for open CAD/CAM.

index

dentalarabia

.ME

Most Products. Best Search.

Find thousands of products on our website.

Clicks & Picks What dentists were searching and savoring in August @dentalarabia.me

E-newsletters

3 Most-Viewed Products

Clinical and Techniques Practical clinical advice, research and techniques

Product launches and updates from throughout the industry

11 A close look at CBCT

24 Clinically speaking, 3D a must have

and its ROI benefits

Part II of a three-part series on how CBCT is transforming treatment planning for implants.

Once you make your high-tech purchase, how do you know you’re getting the most “bang for your buck?” One dentist shares his thoughts.

TECHNIQUE 26 Remove gingival pigmentation

technology evangelist

with a diode laser

12 The amazing technology we are (or should be) using everyday

Are you taking technology for granted? Here’s a break down of technology that can help improve your practice and why you should be using it if you’re not already. double take

and add to your short list...” It may take a lot to “wow” DPR’s technology evangelist,

28 The finishing touches

30 Simplify the direct restorative process

Using a universal adhesive with multiple composite resins from Ivoclar Vivadent for great clinical results.

double take

34 Applying Planmeca PlanScan

clean, adaptive to patient and provider.” Cover Story

16 Ceramic Implants

The significant progress that has been made in terms of development of materials, techniques and design of dental implants have supported the emergence of metal-free implantology that uses implants made of zirconia as the most reliable implantable bioceramic.

02 Diagnocam Kavo Dental

in your practice

A closer look at this ultra-fast intraoral scanner for open CAD/ CAM.

35 Applying SmartLite® Focus in your practice

A closer look at this new pen-style LED curing light.

36 Applying Sapphire Plus in your practice Sapphire Plus generates and delivers maximum curing and whitening power to the restoration...

37 Solutions to everyday problems

How one clinician is using Dentsply Caulk’s Aquasil Ultra Cordless impression system to solve problems.

products in practice

DMG

New Product Lines Added to Website

Product impact on the practice’s bottom line

3 Most-Read Articles online

01 Zabadne Sterling Dental Smile Design Weekend

38 Is your practice ready for Autism? As the number of children diagnosed with autism continues to grow, it’s important for you and your team members to know what products to avoid and what products work best when treating patients on the autism spectrum in your practice.

02 USDA 2nd International Student’s

Make your inbox happy! Register for Dental Arabia ME e-newsletter and never miss a web exclusive article. Go to dentalarabia.me and subscribe.

Dental Conference 2014

03 Products Changing the Way Patients

MARKETING

See Dentistry

40 Improving telephone skills can pay off big

Examining existing internal processes can improve your marketing ROI without additional costs.

Getty Images / Tempura

New products

Also in this issue a look at

22 Orangedental The List

25 Top 4 ways to extend the life of dental materials

PORTION CONTROL

39 Maintaining expenses is all about divvying things up correctly.

on this page 42 Here are some of the most

popular products from our online product database.

Our mission Dental Arabia Middle East DPR provides dentists with comprehensive, accurate and unbiased information across the spectrum of specialties. In consultation with forward-looking clinicians and manufacturers, our staff supports dentists as they apply new products and technologies for excellence in patient care and practice development.

03 Icon

How SDI Aura saved the day for a college student who wasn’t happy with the results of her orthodontic treatment.

TECH BRIEF

One clinician’s view of the A-dec 500 Chair System with the EA-52 LED electric motor handpiece.

A clinical case the illustrates the use of a digitally pulsed high power diode laser with minimal anaesthesia for gingival depigmentation.

but this curing light from Kerr definitely caught his attention.

15 “The delivery system is easy to

Neobiotech

protocol

IMPLANT

inside look

14 “You need to check it out

Product watch

01 FR Kit

AUGUST 2014

eCEMENT™

A light-cured, resin-modified calcium silicate filled base/ liner, TheraCal LC is designed for use in direct and indirect pulp capping and as a protective base/liner under composite, amalgam, cements and other base materials. Said to provide precise placement for use in all deep cavity preparations, its proprietary formulation allows for a command set with visible light curing. The proprietary hydrophilic resin formulation creates a stable and durable liner or base.

eCEMENT offers a light-cure and dual-resin cement to ensure lithium disilicate restorations provide long-term retention of single or multiple restorations, as well as shade stability. Additionally, the radiopaque cement offers easy placement of lithium disilicate veneers, onlays, crowns, threeunit bridges and inlays.

shop the magazine - buy the product Bisco bisco.com

www.dentalarabia.me

Itena Pure Boost

TheraCal LC®

www.dentalarabia.me

Bisco bisco.com

The Pure Boost portable device reportedly optimizes the oxidation capacity of the gel and improves whitening results by 30%. It works by speeding up the activation of the office whitening gel by progressively increasing its temperature. A rise in temperature of 10°C increases the decomposition of hydrogen peroxide by a factor of 2.2 (International Associations of Dental Research – IADR). Heat improves diffusion of hydrogen peroxide through the tooth structure. Itena itena-clinical.com

AUGUST 2014

We want to know what you think about Dental Arabia ME. DPR Your comments are always welcome! Email mohanna@dentalarabiame.com.

From The EDITOR

voice

Dear Readers, We had a very nice period in the last few months. In July we celebrated the Holy month of Ramadan and June was marked by the APDC conference and exhibition in Dubai chaired by our Dr. Aisha Sultan, Head of Dental Services in Ministry of Health and Head of Dental Chapter of Emirates Medical Association.

products inside this August issue

At this event we had a pleasure of seeing some of the companies that have already presented themselves in other events in the region, and we certainly saw some new ones. In the product watch section we are showing you the products that caught our eye at the exhibition, among which we do have some classics but also products that are making their way into our market. For example, Orangedental as one of the newer companies to join the market in the region offers several very unique products that you can read more about in the product watch as well the Orangedental company profile. What we have noticed during this period is the rise of ceramic implants as alternative to titanium implants. We are therefore dedicating the cover story to an Association specially devoted to metal free implantology - The International Academy of Ceram Implantology as well as one of the ADA approved ceramic implants systems Zirkolith® from Z-Systems.

212-951-6600 | Fax: 773-847-6486 | dpr@advanstar.com dentalproductsrepor t.com

Editorial Offices Executive Vice President Georgiann DeCenzo

Product watch

Group Editorial Director Kevin Henry Editor in Chief Stan Goff Managing Editor Renee Knight Senior Editor Ryan Hamm Content Specialist - Database Michael Quirk

22 PRODUCTS to GO

Director of Business Development Thais Carter E-media Director Steve Diogo Content Specialist - Marketing Greta Lieske Technology Editor Dr. John Flucke Art Directors Steph Johnson-Bentz, Kristen Morabito Production Director Jesse Singer Audience Development Manager Kristina Bildeaux, 507-895-6758 List Sales Carissa J. Simmerman

Futudent Camera

Permissions/Licensing Maureen Cannon, 440-891-2742

Futudent is positioned as the world’s leading dental HD imaging & communication solution for dentists. Designed and produced in Finland, this product combines a 16gr/0.56 ounce head-mounted HD camera with easy-to-use video software and a cloud service to instantly share images and videos with patients, colleagues, teachers and students. The hands-free operation does not interrupt procedures and enables instant sharing of the image and video on a screen and by email. In clinical settings it can be used for patient communication and sharing of videos with colleagues. Furthermore, used for recording instructional videos makes it a valuable teaching tool, as well as a learning tool for students, which can document their hands-on practice in an easy and cost-effective manner.

Middle East edition editorial team Dr. Mohanna J. Abbas BDScieDent, MSc Dr. Ninette Banday BDS, MSc Dr. Sara B. Baldo BDS, MclinDent (Paedo)

We are very happy to see our website dentalarabia.me gaining more visitors and subscribers by the day and we are working on getting even more products to be available to be bought online. We are featuring several popular products in the dentalarabia.me page.

Marketing Manager – Dr. Bisera Lakinska, MBA

Dr. Bisera Lakinska DDS, MBA Managing Director – Dr. Mohanna Abbas Art Director – Shahzad Mohammad Coordinator – Jade Chavez

Futudent futudent.com

AUGUST 2014 Copyright (2014) Advanstar Communications Inc. All rights reserved Dental Arabia Middle East -Dental Products Report (DPR) is a trademark belonging to Advanstar Communications Inc., located in Duluth, Minnesota, USA. Dental Arabia Middle East is published by Marja Media Solutions under the license of Dental Products Report

Truly yours,

Vice President/General Manager John Schwartz

In the last two months we did see several new products come out, among which is the launch of the new treatment center of Sirona – Intego, that was introduced on an event with excitement and energy that we don’t see every day in our trade.

Among the many useful articles in this issue, we are glad to publish a case about a very original application of a diode laser and an indication specific to the region – gingival depigmentation, by our colleague Dr.Bassam M. Ahmad. Make sure to check it out and consider offering this highly sought esthetic procedure.

Dubai Media City, Al Thuraya Tower No.02, Office No.44

More products…

P.O.Box: 500717, Dubai, United Arab Emirates

Dr. Mohanna J. Abbas mohanna@dentalarabiame.com

Phone: 800 DNTL ARBA, Email: contact@dentalarabiame.com www.dentalarabia.me

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Get Connected Visit

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www.linkedin.com/company/dental-arabia-middle-east Dental Arabia Middle East DPR makes every effort commensurate with professional editorial and advertising standards to report manufacturer’s product news accurately, but cannot assume responsibility for the validity of product claims. It is necessary for the editorial staff to remove itself from policing the content or images used in various ads or marketing campaigns. Any reader with a complaint should contact the manufacturer directly. Dental Product Report Awards

65 APDC products

Italian Couture Scrubz - Pastelli Pastelli is an Italian brand of couture scrubs and are said to be made entirely in Italy and 100% in the plant of the company.

10 new products

KaVo ESTETICA E70 T and E80 T in Orchid Pink The KaVo ESTETICA E70 T and E80 T treatment units are now available in the new KaVo Design Edition pink orchid that adds color to the dental office.

16 cover story

Ceramic Implants The significant progress that has been made in terms of development of materials, techniques and design of dental implants have supported the emergence of metal-free implantology that uses implants made of zirconia as the most reliable implantable bioceramic.

2009 Winner Best Redesign

AUGUST 2014

www.dentalarabia.me

AUGUST 2014

PRODUCT wATCH

APDC PRODUCTS

PRODUCT wATCH

APDC PRODUCTS

Ankylos 6.6 mm Implant Orangedental Pa-on Periometar

Tri Hawk Burs

Orangedental’s pa-on Periometer is said to be the first periometer for fully automated assessment of periodontal status, Orange Dental’s pa-on Periometer facilitates the work of the dentist in determining the periodontal status and enhances the communication with the patients, by providing them with automated visualisation of the results. The probe accredits more time for the practice staff, since the perio-charting can be done with the assistant and due to the disposable syringes, the system is hygienic to use. It is cable-free probe, with automated data transmission from the docking station. It is pleasant for the patient, exerting precisely 20 g of pressure.

Tri Hawk focuses exclusively on manufacturing dental burs and advocates the use of a simplified selection of single-use burs. Their regular carbide and crowncutting burs reportedly deliver un-matched cutting speed, due to the unique blade and rake angle designs. The burs are made by induction welding and build from proprietary steel blend, which makes them highly resistant to breakage. In addition, the burs offer increased visibility due to their black shaft that contrasts with both, the cutting end of the bur and the material being cut. Tri Hawk trihawk.com

Dentsply Implants dentsplyimplants.com

Orangedental orangedental.de

Denmat Perioptix Loups The light weighted frames and head-lamp design of the Perioptix loupes reportedly support better ergonomics, resulting in less strain on the neck and overall a more comfortable working experience. The PeriOptix loupes are available as readymade and custom loupes. At APDC, clinicians could get their Perioptix pair fitted at the DenMat stand, by measuring their inter-pupillar and working distance. Featuring a unique modular frame system, the frames are designed by premium brand names, such as Adidas, Hogies, and Univet. The flip up style loupes feature a proprietary locking mechanism, designed to simplify the adjustment. DenMat denmat.com

Dentsply Implants has launched the new short ANKYLOS 6.6 mm implant which is indicated where vertical bone height is limited. It may minimize the need for vertical bone augmentation procedures and therefore reduce treatment time and costs. The ANKYLOS 6.6 mm implant reportedly has the same friction-locked and keyed tapered TissueCare connection as all ANKYLOS implants, preventing micro-movements between the implant and the abutment. It completes the already existing portfolio of implant lengths, which include 8/9.5/11/14 and 17 mm and is available in the same diameters of 3.5/4.5/5.5 mm. To ensure simplified handling and treatment efficacy, all corresponding ANKYLOS instruments have been provided with an additional depth marking for the new implant length which must be used when placing this implant.

Distributed by: Zabadne Sterling Dental lumineers.me

AUGUST 2014

3M ESPE Filtek™ Bulk Fill Flowable Restorative This flowable restorative from 3M ESPE comes in syringes and capsules and in several shades: A1, A2, A3 and Universal. Recommended for bulk fill liner/base application, its flowable viscosity provides good adaptation, and its 4mm depth of cure reduces the need for layering. The manufacturer reports that Filtek™ Bulk Fill offers better wear resistance, maintains low stress and shrinkage and has higher compressive and diametral tensile strength than competitors and can therefore be confidently used as a bulk full composite. The capsules, syringe tips and plungers are designed in a bright orange color for easy and quick identification in the operatory.

www.dentalarabia.me

The smart-pad provides disinfection of inflamed periodontal pockets, through application of LED photo-activated tolonium chloride solution (a photo - active substance in 12.7 µg/ml concentration) directly in the root canal. This enables effective disinfection of the root canal by selectively destroying the outer bacterial cell wall and killing 99.99 % of the present bacteria within seconds. It does not require use of antibiotics; hence the bacteria do not get a chance to develop resistance. This disinfection method requires minimum root canal shaping, thus it preserves the dental substance and allows for natural remineralisation. Orangedental orangedental.de

New Zsystems Implant - Z5 Active The Z5 active is the newest product from Zsystems. As reported by the manufacturer, it is specially developed for getting maximum stability even in compromised bone situations, as soft bone or direct after extraction. Through the same unique features as the other Zirkolith implants, it preserves the biology of the marginal hard and soft tissue. Z5 active also features the unique SLM surface with higher roughness for increasing implant stability and long term success. Z5 active is positioned as an easy to use, all-ceramic implant for all cases that need maximum stability and excellent esthetics. Zsystems zsystems.com

3M ESPE 3mespe.ae

Orangedental Smart-pad

www.dentalarabia.me

Elexxion Pico Diode Laser Made in Germany, The Elexxion pico laser is very compact and portable, weighs 590 g and measures 11.5 cm in high, 9cm wide and 2.8 cm depth. As a Class 4 dental laser, the beam has a wavelength of 810nm +/- 10nm and maximum pulse power output of 5W. This laser can be used for various indications in endodontics, periodontology and oral surgery. Elexxion elexxion.com

AUGUST 2014

PRODUCT wATCH

APDC PRODUCTS

PRODUCT wATCH

APDC PRODUCTS

LED Dental Light POLARIS As reported by Gcomm, this dental light doesn’t generate UV rays and offers the possibility to adjust several settings to enable more pleasant work and increase visibility of the working field. The color temperature regulation makes it possible to adjust it from 4.200° K to 6.000° K in order to improve the contrast on soft tissues. It is also possible to adjust the illuminance from 8.000 to 35.000 lux, depending of the specific application, reducing eyestrain. The geometry of the reflectors in combination with each LED source, produce a luminous flux, which is homogeneous, clean and without shadows. Available in different RAL colors, it can be mounded on the unit, the ceiling, a wall or on the floor.

Cerkamed MTA+ As reported by Cerkamed, the MTA+ is characterized by nanoparticles that are three times smaller than the particles of similar material produced by other manufacturers. The product also features high concentration of calcium ions, which make the remineralising and bacteriostatic properties. The silicon-calcium compounds contained in the MTA + help to rebuild dental tissue after perforation and intra-canal resorption and the bismuth oxide gives the material high radiopacity.

Biolase Epic Diode Laser

NSK Endo-mate TC2 Handpiece

Italian Couture Scrubz - Pastelli

This diode laser is controlled by a full-color touch screen and provides three distinctive treatment modes: surgery, whitening and pain therapy, which makes it clinically versatile laser. It provides 10 Watts of peak power and is fully portable. The Comfort Plus setting delivers precisely controlled micropulses of diode energy to the tissue, followed by down time to allow the tissue to positively respond.

This cordless endodontic handpiece features lightweight ergonomic design. Reportedly the slim head and neck assures higher visibility. It is operated by a large LCD panel with 5 programs for different file systems as well as torque control. It has an auto-reverse and alarm function and can be quickly charges in 90 min. The autoclavable MPA and MPAS heads are equipped with a built in probe ring which allows for the use of an Apex locator which enables the clinician to perform more accurate root canal preparations.

Pastelli is an Italian brand of couture scrubs and are said to be made entirely in Italy and 100% in the plant of the company, where each work phase is carried out, starting from the formulation of the fabric to the design, cutting and finishing phases. Pastelli scrubs are available in many models, made with great attention to details and style to bring out the uniqueness of the professional wearing it.

Biolase biolase.com

Cerkamed cerkamed.pl

NSK nsk-dental.com

Gcomm gcomm-online.com

Carriere Distalizer Appliance

Lateral Sinus Approach Kit – Neobiotech CEREC Omnicam

W&H Alegra Turbines The Alegra high speed handpiece reportedly has an integrated LED generator and therefore offers independent daylight quality - regardless if couplings or dental units have light sources available. The self-generated LED+ light is neutrally colored and many times brighter than conventional halogen light. It also features ceramic ball bearings, triple spray and is maintenance free due to the hygienic head system. W&H wh.com

Featuring an ergonomic handpiece and special optics, the CEREC Omnicam intraoral camera has ColorStreaming to allow for continuous capture of the oral cavity as well as displaying 3D data in full color. The system is completely powderfree. The slim, rounded camera tube provides for easy rotation of the camera in the intraoral space. The tiny camera tip makes it easy to best position the lens anywhere in the mouth. The camera captures images in 2D and 3D and can rapidly capture half-arch and full-arch impressions. Sirona Dental Systems Inc cereconline.com

AUGUST 2014

Pastelli pastelli.com

This surgical kit reportedly provides ultimate solutions for the cases of only having with a thin residual bone height which is difficult to approach with a crestal technique, membrane rupture by a sinus crestal approach or placing multiple implants. In addition, SLA reamers can be easily adapted for the case of formation of minimum flap size on the inferior wall. SLA Kit Lateral window technique is the formation of the access to the maxillary sinus through its lateral wall. The process using this tool is simpler and much comfortable than any other techniques. Neobiotech neobitoech.co

www.dentalarabia.me

WorkFlow Scrubs by Landau The US brand Landau, manufacturer of medical uniforms for 50 years, has introduced the WorkFlow by Landau- scrubs made of stretch fabric, which is soft and durable, and available in many colors to bring freshness and energy in the dental office. Landau landau.com

The Carriere Distalizer Appliance is said to correct the posterior occlusion to an ideal Class I platform first by rotating and uprighting the maxillary first molars while distalizing the posterior segment, from canine or premolor to molars, into a perfect occlusion. Simultaneously it produces a light, uniform force for distal molar movement. The appliance Independently moves each posterior segment, from canine or premolar to molar, as a unit. Used at the beginning of treatment when there are no competing forces in the mouth, the appliance allows the distalization of the molars and premolars from 3 to 6mm range, on average. Carriere carrieresystem.com

AUGUST 2014

PRODUCT wATCH

NEW PRODUCTS

PRODUCT wATCH

inside look

“

A close look at CBCT and its ROI benefits Once you make your high-tech purchase, how do you know you’re getting the most “bang for your buck?” One dentist shares his thoughts. [ By Dr. Eugene Antenucci ]

Sirona INTEGO Treatment Center The new Sirona INTEGO treatment center has features that reportedly aim to provide optimal support for both the dentist and the patient. The ergonomic design provides optimal access to the patient and smooth treatment workflow with a high level of patient comfort. This unit is available in two models - INTEGO or INTEGO Pro, a whip arm or a hanging hoses design and is highly customizable to accommodate the needs and preferences of every dentist. You can choose between two headrests, two operating lights and two assistant elements. You can also include options to prepare the unit for future applications such as an Integrated USB interface and a SIVISION 22” AC monitor.

KaVo ESTETICA E70 T and E80 T in Orchid Pink The KaVo ESTETICA E70 T and E80 T treatment units are now available in the new KaVo Design Edition pink orchid that adds color to the dental office. The refreshing and trending pink can be applied to the upholstery as well as the accessories and the new KaVo PHYSIO® Evo dentist chair for an extra flair.

Dr. eugene antenucci Huntington, N.Y.

Practicing dentists are faced with daunting choices when it comes to incorporating advanced technologies – CAD/CAM, lasers, digital radiography, implant surgical devices, 3D computed cone beam radiographic imaging and computer-based management – as well as educational, promotional, and diagnostic technologies that lead the list in 2014. The purchasing decision-making process

KaVo kavo.de

Sirona sirona.com

is difficult in and of itself; dentists have to balance perceived needs and benefits with the pull of strong, focused marketing information and hopefully a high level of business ROI analysis. But once you make your new purchase, what then? Here is some advice I have learned from working with other dentists and incorporating my Planmeca ProMax into my practice. 1. Invest in education for the dentist and staff to develop a working knowledge of CBCT for the entire team, which includes image acquisition, fluency with the imaging software, and a basic understanding of CBCT image interpretation. This will

Planmeca ProMax 3D DenMat Lumi Smile Home Whitening A take-home whitening solution, LumiSmile White from DenMat is available in 32%, 22% and 16% carbamide peroxide concentrations, and is said to offer reduced sensitivity, real peppermint oil flavoring, and 18 months of refrigerationfree shelf life. To create LumiSmile White, DenMat reportedly tapped some of the world’s foremost experts in teeth whitening to optimize its formula. To address patients’ concerns regarding sensitivity during and after treatment, DenMat replaced the glycerin in the initial test formulas with propylene glycol, which minimizes dehydration of the teeth, while H20 and potassium nitrate enhance patient comfort. DenMat denmat.com

Distributed by: Zabadne Sterling Dental lumineers.me

AUGUST 2014

ProMax 3D with patented SCARA technology is a multi-purpose unit that provides clear, dependable 2D/3D imaging with versatile imaging programs and volume sizes to accommodate a wide range of clinical needs. It also offers users the freedom to upgrade to cephalometric, ProFace 3D facial photo, and digital impression/cast model scanning modalities.

Carestream Dental RVG 6200 Offering a number of user-defined image processing tools, the new RVG 6200 is said to allow for the customization of images according to the practitioner specifications for enhanced diagnosis and easy use. Three anatomical image enhancement modes can be applied to acquired images, including endodontic, periodontic, and dentin-enamel junction. The user-friendly sharpness filter with dynamic slider bar makes it easy to see contrast changes in real time. Using sharpness ranging from 0 to 6, dentists can choose the image contrast of preference, as well as the anatomical mode and sharpness level, which can be saved as a custom default setting.

Planmeca planmeca.com

allow a practice to acquire images consistently and interpret the data quickly and accurately on command for optimal benefit. 2. Develop a clearly defined practice protocol for when images are taken. CBCT is not designed to replace 2D panoramic images, but a CBCT study will provide information that 2D images cannot provide. A practice protocol or flow sheet will standardize the use of CBCT for maximum benefit. 3. Every practice needs to have a concise understanding of the procedures for which that particular practice will utilize CBCT. Each practice will differ according to the procedures they perform. With this knowledge, the practice can analyze past need historically and use this information to develop ROI figures. For devices such as the ProMax 3D by Planmeca, this would include the number of 2D Panorex images that would be taken. For example, three pans a week at $125 per image ($1,625/month), eight implant CBCT studies per month at $375 each ($3,000/month), five CBCT studies of impacted third molars at $200 each ($1,000), and five CBCT studies of endodontic cases at $200 each ($1,000). This minimal use would generate $6,625 in revenues monthly, providing an excess of $4,000 in direct profits monthly or $48,000 annually, without consideration for production from procedures generated by the diagnostic information from the imaging. Knowledge of the type and frequency of procedures performed on a monthly basis removes the guesswork from calculating and planning ROI.

Every practice needs to have a concise understanding of the procedures for which it will utilize CBCT. Each practice will differ according to the procedures they perform.”

about the author Dr. Eugene Antenucci’s expertise in the clinical integration and utilization of advanced dental technologies has assisted many dentists in making sound decisions in working with and profiting from technology in practice. As an international lecturer, his programs have provided hundreds of attendees with concrete and usable information on the practical applications of technologies such as digital impressioning, intra and extra-oral imaging, digital radiography, dental lasers, CBCT imaging and office automation, as well as the incorporation of social media and the Internet in dental marketing in order to increase a practice’s visibility and flow of new patients. He maintains a full-time restorative, implant and cosmetic private practice in Huntington N.Y. Dr. Antenucci currently serves as a Clinical Assistant Professor at NYU College of Dentistry teaching implant surgical and prosthetic dentistry. He is a Diplomate of the International Congress of Oral Implantologists and a Fellow of the Academy of General Dentistry. Eugene has served in numerous leadership roles with the Academy of General Dentistry at both the State and National levels. He has many years of experience with chairside CAD/CAM and Cone Beam Imaging, and incorporated the Planmeca ProMax 3D in his practice in 2008.

Carestream Dental carestreamdental.com www.dentalarabia.me

www.dentalarabia.me

AUGUST 2014

PRODUCT wATCH

technology evangelist

PRODUCT wATCH

“Innovation is important and it pays to continue to keep up to date and evolve.” Digital SLRs are not expensive and provide many benefits. If you think they are difficult to use, remember there are companies that will set them up for you and make them practically “point and shoot,” with incredible color and resolution. If you think downloading the photos is too time consuming, buy an Eye-Fi SD card that will automatically transfer your pictures to your computer over your wireless network. Incredible!

The amazing

technology

Intraoral cameras

we are (or should be) using

everyday

About the author John Flucke, DDS, is Technology Editor for Dental Products Report and dentistry’s “Technology Evangelist.” He practices in Lee’s Summit, Mo., and has followed his passions for both dentistry and technology to become a respected speaker and clinical tester of the latest in dental technology, with a focus on things that provide better care and better experiences for patients. He blogs about technology and life at blog.denticle.com.

Are you taking technology for granted? Here’s a break down of technology that can help improve your practice and why you should be using it if you’re not already. by D r .

the amazing devices we use (or should be using) every day.

John Fluck e

was thinking the other day about change. Well, heck, I’m always thinking about change. After all, that’s what I do here, right? However, this time it really sort of hit home for me. I was thinking about my “new” office. In December, I will have been

AUGUST 2014

Computers in the “new” facility for six years. That means I moved into the new place in 2007! 2007??? That’s right, 2007. That’s the year that Steve Jobs introduced the first iPhone, Al Gore won the Nobel Peace Prize and the last book in the Harry

Potter series was published! So with all of that nostalgia rattling around in my brain, I decided to take a look at some of the technology we have available to us that we, perhaps, take for granted. For this article, let’s take a walk down memory lane and think about some of www.dentalarabia.me

First and foremost is the operatory computer. If you have not yet brought computers into the operatory, what are you waiting for? In addition to all the efficiency it adds to delivering dental care, the computer also creates an amazing patient experience. We use the computer to deliver Guru patient education, stream in music via Pandora www.dentalarabia.me

or iHeart radio, watch TV (via cable TV connected to the computer), show movies during long procedures, and some patients even play computer-based games!

Digital cameras You can see so much with a good digital SLR camera. Even for procedures such as before-and-after whitening shots, a digital camera is a must-have. Using one to capture a standard series of shots of every new patient is quick and easy.

better for the environment (greener), more efficient (cuts costs), and the time it trims from procedures—it makes both sense and cents. When you think about radiography, it’s one of the procedures that we use every day (and really couldn’t practice without). When viewed in that context, why would someone not want to go digital?

Patient education

These devices are truly one of the “unsung” heroes of the dental office. Ours is sleeved and ready to go for every procedure and every hygiene visit. Taking a before, mid-treatment, and after photo on every case provides a complete visual history of your patient and the procedures you’ve performed. It also allows you fast and easy ways to educate patients on why procedures are necessary and helps justify treatment to third-party payers. Considering how affordable these devices have become, I suggest putting one in every operatory. With hard drive space so plentiful, there’s no reason not to take lots of pictures every day. One other advantage is an intraoral camera’s value in case of a lawsuit. As Peer Review Chairman for the state of Missouri, I can tell you that meticulous record-keeping, good documentation and photos help show clinical situations clearly and without misunderstandings. They are also invaluable tools in helping patients make informed decisions.

All of the things I’ve mentioned in this article are—in one way or another— visual tools. Studies show that somewhere between 75 and 85 percent of what we perceive about our environment comes to us through our eyes. That stat alone should be enough to have a doctor considering some type of patient education system, but there are even more reasons! In dentistry, we are trained to use our skills to help others, and we do that very well. What we really aren’t well trained to do is to explain why our treatment is necessary. Using a system like Guru, CAESY, ConsultPro or others lets communication specialists bring the message to the patient while the providers do what they do best. These systems provide all the information prospective patients need in verbiage they understand and use images that are educational but not scary. Regular use of programs such as these can be a tremendous boost to your practice and help you gain referrals because patients truly understand why treatment is needed.

Digital radiography

Wrapping it up

The latest stats I’ve seen indicate that somewhere between 50 and 60 percent of dentists are using digital x-ray. I feel all the arguments about how digital is inferior to film have been pretty much put to rest. Digital, at its bare minimum, is at least equal to film. When you begin to factor in all the other advantages—such as lower radiation dose (patient safety),

Innovation is important and it pays to continue to keep up-to-date and evolve. However, it also pays to work with and stick with those things that are proven and reliable. The only constant is change. Just make sure, as you change, you don’t forget those things that got you here in the first place!

AUGUST 2014

PRODUCT wATCH

double take

“

double take

“The delivery system is easy to clean, adaptive to patient and provider.”

You need to check it out and add to your short list...”

One clinician’s view of the A-dec 500 Chair System with the EA-52 LED electric motor handpiece.

It may take a lot to “wow” DPR’s technology evangelist, but this curing light from Kerr definitely caught his attention. [ Compiled by Kevin Henry ]

[ Compiled by ANNA SACKS ]

A-dec 500

dr. john flucke lee’s summit, mo.

Just ask Dr. john flucke why he likes having the Demi Ultra Ultracapacitor Curing Light from Kerr in his practice and he’s very quick to answer with a range of the product’s positive attributes. We asked Dr. Flucke to give us some of the highlights of this curing light and what has jumped out at him about it and its use in his practice.

What do you like best about this product? This is a really nice light. I’ve really enjoyed my time using it. The Demi Ultra takes the concept of cordless curing devices a step further. It has “Ultra” in its name because it uses an ultracapacitor. The tremendous advantage of the ultracapacitor is that you can take a device that is completely dead, has no battery charge left, and can’t even be turned on and you can place it into the charger and it will have a full charge in roughly 40 seconds. That’s just amazing. When fully charged, the device will provide 25 10-second cures. That may not seem like a lot, but that’s taken care of 95 percent of the restorative situations that I have in my office on a daily basis. We’re all familiar with rechargeable batteries. We also know that, over time, those batteries lose the ability to hold a charge. That doesn’t happen with the ultracapacitor. It has a lifespan of 10 years so you may replace it in 10 years when new curing light technology comes along but, until then, you don’t have to worry

about replacing a battery or how long your battery is lasting. Another thing I love is that Kerr has moved the LEDs in the Demi Ultra. Rather than being inside the device with a glass guide on the end that transfers the light like so many others on the market, the LEDs in the Demi Ultra are in the tip. That serves a couple of very important functions. First, it takes less energy to have the LEDs in the tip. When the LEDs are in the body of the curing light, it takes a strong boost of energy to get that light through the glass guide at the tip. That puts more of a strain on the battery. Second, having to use less power means that less heat is also being generated. With the LEDs now being located right by the tooth, that’s very important because you cut down on the risk of pulpal inflammation. The device is also a sealed device. It only has one part that you can take off and there are no grooves that allow the heat to escape. With the recessed charging port, you also don’t have to worry about any disinfectant solution getting on the curing light’s contacts. Additionally, the charging station also has a built-in radiometer that allows you to check the curing light’s output.

Would you recommend it to a colleague? Absolutely. I would say that if you’re in the market for an LED curing light or you might be in the near future, you need to check out the Demi Ultra and add it to your short list of devices to try out and bring into your practice.

AUGUST 2014

Built to provide comfort for patients and clinicians, the A-dec 500 dental chair and delivery system allows you to maintain a healthy posture while working closely with patients, reducing pain and discomfort for both practitioner and patient. A-dec a-dec.com

DR. MONICA LEE PRACTICING SINCE 1999

love A-dec’s equipment because I have everything I need

Demi Ultra Ultracapacitor Curing Light The Demi Ultra Ultracapacitor Curing Light’s U-40 ultracapacitor allows the device to fully charge in less than 40 seconds, offering 25 10-second cures without gradually losing charge strength like curing lights powered by conventional rechargeable batteries. This means that the Demi Ultra will have the same charge strength after 10 years of use as it did when it was new. Additionally, the LED light system is outfitted with Kerr’s C.U.R.E. (Curing Uniformity and Reduced Energy) technology, which reportedly offers uniform curing depth at low temperatures, which translates into less heat delivered to the tooth itself.

cords from all of the various instruments we require. I can’t tell you how easy it is to use and how happy I am to make the most of my equipment. Just because you buy it doesn’t mean you’ll use it. If it’s too clunky, time consuming purchased (from A-dec)because it’s so easy to use.

When did you start using this product? I started using the product when I opened my office in March of 2008.

How has it worked out for you so far?

handpiece is quiet, provides incredible visualization and consistently preps teeth at the desired setting. -

ably, quickly and with better accuracy. Although this equipment may cost more initially, it makes our jobs easier. Electric LED handpieces can prep teeth faster than air-driven counterparts and they really don’t sound as whiny, either.

What was the process of incorporating this product like? Incorporating the product was easy because I built the office new. A-dec allowed me to configure whatever I

What has the response to this product been from patients and staff?

rooms. When changes have to be made, it’s pretty easy to rearrange the position and settings of the whole operatory equipment set up. I have multiple hygienists and doctors

your needs?

more comfortable, we care about them. trying to keep the price of doing dentistry low for everyone.

Kerr Dental kerrdental.com

the methods and equipment that help us achieve this goal. I thought this product met that criteria.

Why would you recommend this product to a colleague?

What are the best aspects of this product? The chairs are soft, quiet and beautiful. The delivery system is easy to clean, adaptive to patient and provider. The

www.dentalarabia.me

I would definitely recommend the product to others because you can’t beat the comfort and efficiency that it provides.

AUGUST 2014

COVER STORY

ceramic implants

same spirit not only to organize metal free implantology but also to provide the profession as a whole with quality a nd h igh level cont inu ing i mpla nt education and the public with a greater understanding of the benefits of metal free ceramic dental implants.

Dr. Sammy Noumbissi President of the IAOCI

Dental Arabia ME: Why is there a need for a Ceramic Implantology Association? D r. Nou m bi ssi: A ssoc i at ion s a nd academies exists around various types of trades and industries. The common purpose of such groups is to organize and create a supportive environment for those involved with the organization. The International Academy of Ceramic Implantolog y was created with the

Ceramic

Implants

Modern dental implantology was discovered and introduced over 50 years ago. Since then, significant progress has been made in terms of materials, techniques and design of dental implants. The constant has always been the use of titanium and subsequently of titanium alloys to manufacture dental implants. However, as soon as the late sixties to early seventies the search for metal-free implantable materials began and as a result during the last decade zirconia has emerged as the most reliable implantable bioceramic. Following these developments, in 2011 an association dedicated entirely to the metal free ceramic implantology was founded – The International Academy of Ceramic Implantology (IAOCI) as the only organization of its kind in the world. At APDC Dubai in June we had the pleasure to talk to Dr. Sammy Noumbissi, the founding president of the IAOCI, on issues regarding the association as well as about the state of metal free implantology today. In addition, we caught up with Dr. Ralf Luettmann, practicing implantologist and Co-CEO and Speaker of the Board of Zsystems. 16

AUGUST 2014

www.dentalarabia.me

Exclusive Interview

they can obtain in an evidence-based and organized manner the information, training and skills to deliver the best of care to their patients. As a matter of fact, our membership had doubled in the last two years. When prospective and new members are asked why they

D e nta l A r a b i a M E : W h e n presented with the idea of ceramic implants most dentists dismiss them as unreliable and even experimental but you preside over an organization fully dedicated to ceramic implantology. How is that?

want to join or joined the Academy, the most common response is that they are seeking for a forum where they can get structured information and training. But more interesting is that they have had patients challenge or inform them on the use and occasionally the existence of ceramic implants. Technology and the ease of access to information has enabled the patients gets information faster than us busy clinicians.

Dental Arabia ME: Please give us some background on ceramic implants. What was the motive to explore zirconia as an implant material? Zirconia Implant

Dr. Noumbissi: This goes back to the need to have organized groups even within specialties because in today’s world resea rch a nd appl icat ion of discoveries are moving a lightning speed compared to 20 years ago. Therefore, once you have an environment where most of the time and energy is spent t r ack i ng, fol low i ng, le a r n i ng a nd sharing innovative techniques and materials, members have a forum where

Zirconia Crown on Zirconia Implant

Dr. Nou m bissi: T he use of dent a l implants as a means of teeth replacement h a s i nc re a sed ver y r apid ly i n t he last f ifteen or more years. With that increase in implant procedures, the nu m ber of ma nufact urers has a lso increased. Over the years we have also witnessed the introduction of various alloys of titanium. Now just like with any commercial, pharmaceutical or medical product the widespread use

International Academy of Ceramic Implantology

The International Academy of Ceramic Implantology (IAOCI) was founded in 2011, it is the only organization of its kind in the world. The organization was started with four members, and has had a rapidly growing membership since then. From its inception, the academy has hosted and/or sponsored over fifty educational events and congresses with the aim of representing and promoting metal free dental implantology. Our goal is to consistently deliver top class evidence-based program in ceramic implantology both from the surgical and prosthetic approach. In 2012 we had our first international meeting in Las Vegas jointly with the International Academy of Oral and Maxillofacial Toxicology, then in January of 2013 in Miami we hosted our first stand-alone scientific congress where we had twelve internationally renowned speakers from Europe, the United States, Canada and Japan. We had in attendance sixty delegates from 11 states in the USA, the UK, France, Japan, Germany, Spain, Jamaica, Canada, and Switzerland (www.iaoci.com). Our next international scientific congress will be held once again in Miami from February 19-21, 2015, this symposium is exclusively dedicated to bioceramics as implantable and restorative materials and the theme will be “Bioceramics in Dental Implantology: From Surgery to Final Prosthetics”. We have fifteen speakers from six countries and expect over 150 delegates. The IAOCI believes and advocates the use of entirely metal free materials for teeth replacement, notably with bioceramics such as zirconia and others.

www.dentalarabia.me

AUGUST 2014

COVER STORY

ceramic implants

Dental Arabia ME: Can you tell us what can we expect from the IAOCI for next year? Dr. Sammy speaking at the last year’s IAOCI Congress

and methods of production comes with problems a nd cha l lenges. A lt hough in it ia l ly anecdota l, reports of titanium and titanium alloy intolerance have increased and are more and more scientifically proven in the dental literature. Based on the body of research available today, this intolerance of implant alloys can in great part be attributed to the release of metal ions in the host bone and surrounding tissue as a result of the breakdown and corrosion of metal alloys in the body f luids and the oral environment in particular. Such facts have been established and widely recognized in orthopedics. In the late sixties pioneers in ceramic implantology and notably Prof. Sami Sandhaus began the search for non-metal implantable ceramic materials. Many of the early ceramic implants were monocrystalline in their structure and did not survive the demands of the oral environment. Then came the use of polycrystals and in the early 2000’s Yttria stabilized zirconia bioceramic emerged as the material of choice for metal free intrabony implantation in dental implantology.

Dental Arabia ME: We had the pleasure to s e e yo u l e c t u r e i n t wo d e nta l conferences in Dubai this year. Dr. Noumbissi : Yes, this year I was honored to be invited as a keynote speaker at the 2nd International Conference and Exhibition on Dental and Oral health in Dubai in April. In addition, together with Dr. Ralf Luettmann we conducted a full day workshop in Advanced Implantology at the 36th Annual APDC meeting. The workshop was a combination of lectures

and hands-on training where all 12 attendees were able to perform placement of zirconia dental implants in artificial jaw models. This program was the first of its kind in the Middle East. During this event I was very happy to learn that the dentists in the region are keeping the pace with developments in implantology and am especially honored to see their interest in metal free implantology.

Dr. Noumbissi: The IAOCI is in the middle of a rapid growth and transformation. Our immediate and upcoming program is our 3rd international Congress which will be held North of Miami in Hollywood, Florida from February 19 to 21, 2015. Next year we will be expanding our international programs to the

Dental Arabia ME: Where do you see ceramic implants heading in the near future? Dr. Noumbissi: Every industry projection you see about implants shows good news for the future. Implants are now and will continue to be widely accepted by patients and the profession. Both groups are identifying that this is state-of-the-art treatment. However, as I mentioned before thanks to technology the public is much more informed and educated about health issues, the level of consciousness about healthy living is rising exponentially. This is most evident with the rise in demand for organic food and the proliferation of natural, organic, non-harmful foods and products. So we are in situation today which is similar to what happened with Invisalign™ braces a few years back where the consumers are pushing the dentists toward metal free implantology for the most part. In five years’ time, I believe the numbers of ceramic implants being placed will double.

AUGUST 2014

IAOCI Congress 2014 speakers

Middle East, South East and Central Asia. We also anticipate launching our one-year continuum program in dental bioceramics and ceramic implantology. The IAOCI also will look back at what the academy has learned in its short 3-year history and summarize current recommendations to address the most challenging conditions in implant dentistry. The IAOCI has enlisted some of the foremost authorities in biomaterials sciences, surgical and restorative dentistry to share their knowledge and views to support this initiative.

www.dentalarabia.me

AUGUST 2014

COVER STORY

ceramic implants

a look at

Tissue is the issue!

Zsystems biocompatibility, less plaque affinity, better esthetics and long- term stability and osseointegration.

Reliable and Predictable Zirconia Implants from Zirkolith®

Dental Arabia ME: Can you please elaborate further about the benefits of ceramic implants? Dr. Luettmann: Recently there have been an increased

Dental Arabia ME: Dr. Ralf, please tell us a bit more about Zirkolith® implants? Dr. Luettmann: The implants are manufactured in

Switzerland, employing our unique and proprietary “Zirkolith®” process, which embraces our vast experience in the f ield of development, material treatment and quality assurance. I have been involved in the invention of the implants myself, bringing in the long clinical experience that I have acquired during my practice as a dentist. The process has been developed and refined in over a decade of research, clinical trials and scientific evidence to reach a 98% implant survival rate today. This excellent result in reliability has not been yet demonstrated by any other zirconia implant company and is on par with the best conventional titanium dental implants. Zirkolith® all ceramic implants are the f irst and only two-piece ceramic implants with FDA approval, which we know is a f irm guarantee for the quality and the safety of the medical devices. Therefore, we quickly became recognized experts in this technology and we have attracted patients from all over Europe and US, placing around 27,000 implants worldwide.

Dental Arabia ME: Why change from titanium to ceramic implants? Dr. Luettmann: Our experience has shown that the

titanium as a material can be as problematic as the other “traditional” dental restoration materials, such as amalgam, resins, and gold alloys. In summary, I can say that there are four aspects in sight when we speak about the benef its of the ceramic implants: higher

AUGUST 2014

number of studies which report immunological reactions attributable to titanium, whereas ceramics are hypoallergenic and immunologically neutral. In addition, it was been proven that the plaque affinity of zirconium dioxide ceramics is lower than that of titanium and other metals used in implants. We know that less plaque means less periodontal and periimplant complications, as well as other general health disorders. Over the years, the issue of aesthetics in dentistry became an increasingly important aspect and the focus of the implants is now on the red-white aesthetics. Now the tissue is the issue. Ceramic implants offer perfect white esthetics without visible grey rings or shadows, even in case of thin or receding gingiva.

Zsystems at ADPC

2-piece

» 12 years experience » 98% CSR** (SLM®-surface) » 10 year guarantee for the implant and the prosthetic components

Dental Arabia ME: What about stability and osseointegration? Dr. Luettmann: The latest-generation Zirkolith® ceramic implants have a special SLM surface in which the increased bone-to-implant contact (BIC) is created by selective laser treatment/fusion, which in turn successfully avoids weakening the material otherwise observed with the acid etching protocol. This process increases the roughness of the surface compared to conventional ceramics by a factor of 4.5 and achieves BIC values of up to 143%, compared to standard ceramics. The osseointegration of this modern surface is comparable with the surfaces of premium titanium implants. The success rate is over 98%, which is on the same level with the surface modified titanium implants. Furthermore, due to the special manufacturing technology we use (the HIP process), the f lexural strength of the Zirkolith® implants makes them stable and long lasting, as the titanium implants. In 10 years I have never seen a broken Zirkolith® implant.

Dental Arabia ME: Does working with Zirkolith® all ceramic implants require any special skills from the implantologist?

* Compound Survival Rate. Data on File.

Dr. Ralf Luettmann Co-CEO and Speaker of the Board of Zsystems

ceramic implants

the two- piece implant was used, the preparation follows the cementation of the abutment. The impression for the final crown and bridge is taken after 2-4 months with the same impression method we use for natural teeth. That’s it. The benefit lies in the obvious fact that there is no need to take open impressions like in the titanium implants, which saves about 80% of the time on the preparation of the prosthetic restoration. Very smart and simple.

Dental Arabia ME: What are the advantages of the twopiece Zirkolith® implant? Dr. Luettmann: The genius feature of the new two-piece Z5c is that it is a split, one-piece implant. After connecting the abutment it behaves as a one- piece implant with all the well-known advantages of the Zirkolith® implants, including eliminating micro-gaps. The two-piece implants are indicated in cases of low bone quality, when immediate loading is contraindicated, or there is a necessity to use angulated abutments. Actually, the therapist can decide whether to use the one-piece or the two-piece implant system during the surgery, since the same instruments set is used for both types.

with lower bone quality. The Z5(t) active is also manufactured with the SLM surface and holds the other well-known advantages of Zirkolith® Implants.

Dental Arabia ME: How about your presence in the Middle East market? Dr. Luettmann: Our goal is to be the first ceramic implant system in the market

here in the Middle East. Our participation in the APDC conference and exhibition was very successful for our launch in the market. Together with Dr. Sammy Noumbissi, we held a workshop for advanced implantology using ceramic implants. We had a very good feedback from the dentists and the Universities. We are currently looking for local representation in order to expand our presence in the region.

Dental Arabia ME: Are there any concerns for cementing abutments? Dr. Luettmann: The abutments of Z5c implants are connected with the implant

through the C3 conical press-fit connection and small amount of cement. The conical connection is well known in the industry, as the most stable connections and gives us a very stable and secure connection.

www.zsystems.com

✔

Dental Arabia ME: The latest innovation is the Zirkolith® active Implant. What are the advantages? Dr. Luettmann: The new Zirkolith® Z5(t) active is a tapered implant. It follows the Zsystems philosophy of making implantology easy, safe and economical. It is specially developed to achieve good primary stability in cases with lower bone quality and can be used immediately after tooth extraction. The new implants can be used with the same surgical instruments set we use in all other Zirkolith® implants, by adding only 3 more instruments. The new system gives more possibilities for immediate implantation and immediate loading, even in cases

EC-Certi ficate

Dr. Luettmann: The Zirkolith® implants follow a very

simple procedure. After the implantation, if a one-piece implant is chosen, it is prepared like a natural tooth and covered up with a temporary crown or bridge. If www.dentalarabia.me

Clinical case - Three Zirkolith implants before cementation

www.dentalarabia.me

Clinical case - After cementation AUGUST 2014

company profile

a look at

enterprise 360°

Orangedental KaVo Dental – Mr. Stefan Kaltenbach. Orangedental has around 50 employees and offers world - wide distribution. Most of our products are made in Germany in our manufacturing plant in Biberach.

Dental Arabia ME: What is unique about your products?

Dr. Saad Abukhader Regional Manager

Dental Arabia ME: Dr. Saad, Please tell us more about your company? Dr. Saad: Orangedental is a German manufacturer of premium innovative solutions for dental practitioners. Since 2003, we develop specialised devices to improve the quality of vision, diagnosis and treatment in the field of dentistry. We specifically focus on X-ray diagnostics, disinfection, periodontics, endodontic, restorative dentistry and development of improved vision appliances, such as dental loupes, dentaloscope and intraoral camera. One interesting fact about our company is that it was founded and it is owned by t he g randson of t he founder of

Dr. Saad: We support and drive the continuous development in dentistry offering premium innovative digital devices for diagnostics and treatment. These devices have opened up new sources of revenue for the dental practices, as well as new ways to improve patients’ satisfaction and experience, also offering ways for dental office to differentiate their services. The high quality of the products we offer is equally important as the quality of the customer services we provide. In this respect, we align the quality and the service to provide a smooth and successful treatment.

Dental Arabia ME: How long have you been present in the Middle East? Dr. Saad: We started our activities in the Middle East in the beginning of 2012. We have successful cooperation with several distributors from the region, among which Al Hayat in the UAE, Kahlid Kadasa Co. in KSA, Central Circle in Kuwait and Across Medical in

cover story technique clinical

Qatar. Together with our distributors, we are present at the biggest events and exhibitions in the region, where we showcase our products directly to the dentists. We will exhibit our portfolio at the next 2015 AEEDC in Dubai and we would like to invite all dentists to visit our boot and experience our innovative products.

Dental Arabia ME: If you can speak in more details about one of your products which one would it be? Dr. Saad: Although it would be difficult to choose one, at this occasion I will speak more about the pa–on Periometer. This is the first periometer for a fully automated assessment of the periodontal status. The device simplif ies and standardizes the recording of the periodontal status. It measures pocket depth and records f indings’ indexes in the process of diagnosis of the periodontal disease. The pa-on Periometer, together with the single-use, disposable, sterilized measuring tips, measures the depth of the gingival pocket and attachment loss and records additional periodontal findings in the frames of the periodontal examinations done by dental professionals (dentists or dental assistants). Measurement values can be read off and manually documented or wirelessly transmitted to specially designed software. The ByzzParo software is one of the possible software products for

recording, saving, archiving, visualizing and documenting the findings of such periodontal diagnoses.

team approach Solve my problem tech brief

Dental Arabia ME: What news can we expect from your company in the near future? Dr. Saad: I am excited to announce our new product – the Freecorder®BlueFox. This device is the key to digital dentistry and is a part of a complete chain of processes, ranging from contact-free, opto-electronic recording of mandibular joints, to computer-integrated planning tools and systems for navigated implementation of planning and highprecision milling techniques for fabrication of prostheses. The ultimate goal is to integrate these new technologies into a barrier-free workflow management and to offer novel logistics and advanced services, enabling the dentists to provide quality-certif ied, effective and efficient medical performance. Using Freecorder®BlueFox, interfaces with conventional dentistry. It allows for a gradual introduction of novel technologies and improved treatment methods into in the dental practice. The revolutionarily straightforward, contactfree and affordable mandibular joint recording with Freecorder®BlueFox opens entirely new approaches to the diagnosis and treatment of conditions of the mandibular joint.

[ in this section ]

dentistry at its

Freecorder®BlueFox

VERSITILITY

26 Technique 62

Remove gingival pigmentation with a diode laser A clinical case the illustrates the use of a digitally pulsed high power diode laser with minimal anaesthesia for gingival de-pigmentation.

In this issue in Clinical & Techniques we have some old and some new

Featured Products Pa-on Periometar

clinical & Techniques

30 technique

techniques to apply in your practice.

Simplify the direct restorative process

Make sure you check a diode laser

Using a universal adhesive with multiple composite resins from Ivoclar Vivadent for great clinical results.

application for gingival depigmentation

Smart- Pad

in the How To article on page 26.

Orangedental GmbH & Co. KG

Aspachstr. 11, D-88400 Biberac, Germany Phone: + 49 (0) 7351 / 474 99-0 Fax: + 49 (0) 7351 / 474 99–44 Email: info@orangedental.de http: www.orangedental.de

36 80 tech brief

Applying Sapphire Plus in your practice

Periodontal status: faster, standardised and fully software-integrated. The first periometer for a fully automated assessment of the periodontal status.

AUGUST 2014

Revolutionary, digital, functional The digital recording device for measurements of temporomandibular joint movements.

Sapphire Plus generates and delivers maximum curing and whitening power to the restoration with the new Power Conversion Technology.

Efficient disinfection The photo-activated oral disinfection for dental hygiene.

www.dentalarabia.me

AUGUST 2014

clinical &techniques

IMPLANT

The take-aways ȜȜ ȜȜ

All areas of the mouth, or areas to graft benefit through CBCT. CBCT can deliver simpler implant and bone graft cases.

Clinically speaking, 3D a must have Part II of a three-part series on how CBCT is transforming treatment planning for implants.

At a glance

There is not one area of the mouth that should be excluded for a CBCT when treatment planning for dental implants or bone grafts. All four quadrants in the mouth require a CBCT to prevent iatrogenic damage and avoid anatomical pitfalls. It is easy for a clinician to say it isn’t needed, but when you look at the medical legal protection a CBCT offers, there is really no excuse not to have one. In the anterior maxilla, a CBCT will show the amount of buccal and lingual bone and the corresponding angulation relevant for implant placement in this region. A cross-sectional view on a CBCT of the anterior maxilla can show how thin the bone can be in the midbuccal portion (Fig. 1).

The set-up

Bringing together a variety of voices for the best advice and big ideas.

“With this article, Dr. Tischler continues to develop the protocol for utilization of cone beam CTs in the planning process for placement of implants. In certain cases there is no substitute for a CT, yet practitioners should always help their patients make informed decisions about their care, including whether or not to have a CT in each instance.”—Dr. brien harvey, team lead

52%

Team members Dr. Brien Harvey (Lead) Dr. Michael Tischler Dr. Lee Gause

About the author Michael Tischler, DDS, is a general dentist practicing in Woodstock, N.Y. He is a diplomat of both the American Board of Oral Implantology and the International Congress of Oral Implantologists. He earned his fellowship with the AGD and American Academy of Implant Dentistry. He lectures extensively and received the Feltman Hunn Medal Of Merit Award in 2007 for his contributions to the field of dentistry.

The products that appear in conjunction with this article are for illustrative or informational purposes only. Their inclusion does not denote endorsement by the author of this article.

of GPs offer implants services in their practice.

Dr. Joyce Warwick

the March issue of Dental Products Report I started a three-part series about treatment planning for dental implants with Cone Beam CT imaging (CBCT). In that article, the basics of CBCT imaging were outlined and the importance to treatment planning for dental implants was made clear. Also it was shown how by using various CBCT imaging companies such as 360imaging in Atlanta or nSequence in Reno, Nev., little investment is needed to use this technology.

what’s next?

A 2D view from a panograph or periapical x-ray can not show this. The often thick palatal tissue in this region is deceiving when attempting to gauge ridge thickness. A CBCT will accurately show the osseous position under this thick tissue. A CBCT will show the position of the incisal foramen from an axial view, which is crucial to treatment planning in this region. When replacing a missing lateral or central incisor, often the bone is concave on the buccal plate due to bone loss (Fig. 2). Only a CBCT can show this anatomy and allow appropriate planning (Fig. 3).

Essential in many cases In the anterior mandible, a CBCT is indispensable. With a 3D view the positions of the mental foramen and mandibular nerve can be identified. It also can show the implant position in relation to other implants, so they are not too close (Fig. 4). Often the lingual anatomy is concave in nature. Only a CT can show this accurately. A 3D view from a CBCT will show the angulations of planned implants. This is important in this area due to the dramatic angulations of the buccal and lingual plates.

In part 2 of this article, I will show the clinical relevance of CBCT imaging to a dental clinician for simpler implant and bone graft cases.

A need for implants According to the Centers For Disease Control, in 2004, 36% of adults over the age of 65 were missing 6 or more teeth, and according to the CDC, 14% of the same adult population in California is missing all their teeth. These facts certainly substantiate the need for implant dentistry. When you look at the literature, over and over again, dental implants offer the

The LIST

Quick bites

for team development and practice success

Top 4

ways to extend the life of dental materials 01

Properly cure your restoration Proper curing begins by placing your curing light directly above your material, as close to the material as possible without actually touching it. Keep in mind it is generally better to cure longer rather than shorter—never less than 10 seconds, and up to 20-30 seconds when needed. Note: Periodically calibrating your light and cleaning the light guide can help ensure your light intensity stays consistent and does not decline over time.

Use a liner/base to extend the life of your restoration Using a resin-modified glass ionomer (RMGI) liner or base offers numerous advantages to extend the life of your restoration. An RMGI liner or base bonds to dentin with a chemical chelation interaction and does not require use of a dentin bonding agent before placement. Additionally, it has been shown to release fluoride ion during service with the potential preventive effect of this chemical. Best of all, it is relatively easy to use.

2 4

FIGS. 1-3 Cross sectional view of

anterior maxilla area showing thin mid-buccal region (Fig. 1). Simulated CBCT view of implant placement (Fig. 2). Surgical view of implant placement in anterior region showing the need to graft at placement (Fig. 3).

FIGS. 4-8 Axial view of mandible showing implant positioning (Fig. 4). Cross sectional view showing lingual shelf (Fig. 5) and cross sectional view of posterior maxilla showing sinus membrane (Fig. 6). Fig. 7 shows pre-op pan view of defect in mandible, while Fig. 8 is a pre-op CBCT 3D view of defect in mandible. www.dentalarabia.me

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Choose a universal adhesive to ensure longterm patient satisfaction Selecting a universal adhesive allows you to utilize your preferred technique (self-etch, total-etch or selective etch) while also providing your patient with a long-lasting restoration. Over-etching dentin or failing to keep dentin moist after etching could result in significant sensitivity and unhappy patients. While in the past dentists may have needed to switch adhesive products within the same case, it’s now possible to take advantage of a simplified process with a universal adhesive while achieving maximum effectiveness.

Part III of the series… Dr. Tischler will tie it all together with CT imaging for larger complex implant cases with multiple implants, and for implants in the esthetic zone.

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best long-term solution for tooth replacement both from a prosthetic survival rate and functional perspective. CBCT imaging, as outlined in Part 1 of this article, is a large part of treatment planning for dental implants. As the U.S. population is living longer, the need to use CBCT imaging to replace missing teeth will only grow.

Using the latest technology

[ by dr. michael tischler]

The Team

clinical &techniques

IMPLANT

Create a tough temporary The simplest way to create a tough temporary for your patients is to select a product known for its strength in both short- and long-term temporary situations. Temporary material with very high flexural strength plus high deflection will result in a temporary restoration with high fracture resistance. Information provided by 3M ESPE.

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Remove gingival pigmentation with a diode laser A clinical case the illustrates the use of a digitally pulsed high power diode laser with minimal anaesthesia for gingival de-pigmentation. [ by Dr. Bassam M. Ahmad BDS, FIBMS ]

Dr. Bassam M. Ahmad, BDS, FIBMS

Dr. Bassam graduated at the University of Baghdad in 1999, with a BDS and achieved his HAAD license as a specialist in Oral & Maxillofacial Surgery in 2011. He has been working in his practice in Al Ain, UAE since then. Background Pigmented gingival tissue or gingival melanin pigmentation (GMP) is a common appearance in parts of the world populated predominantly by nonCaucasians, such as the Middle East and Asia. Literature review shows that the traditional treatment of this phenomenon has been surgical intervention, done in a number of methods1. However, the use of mechanical intervention can cause a severe trauma for the patient and does not treat the melanocytes, which are the actual cause of the problem. Moreover, with the traditional surgical treatment, the patient largely suffers for relatively small effect/ success, with pigmentation returning back within a few months. Carbon dioxide and Er:YAG lasers2 treatments are shown to be effective and less traumatic than the mechanical interventions, but still with up to a 30% recurrence rate of GMP in 6 months (Er:YAG laser). On the other hand, diode lasers (810nm) seem to show a marked advantage over Er:YAG3,4. This case review looks at the non-surgical use of a digitally pulsed diode laser for GMP removal5,6. Case Report My former dental nurse, a

Fillipino national, demonstrates a good example of extensive intrinsic gingival pig-

mentation (Fig 1), which she has had since birth. Often within the Middle East we see more localised gingival pigmentation, which is relatively easier to treat The treatment protocol that was used for this treatment was published in the Laser Journal, in February 20095, by Kenneth Luk, a Hong Kong based Dentist. It was based on laser treatment, with the use of elexxion claros 30W, digitally pulsed laser we have at our clinic. STEP 01 The patient was given half a cartridge of local anaesthetic, with the aim to preserve some sensation in the area to be treated and to and to allow for a certain level of numbing, against the action of the laser.

The laser used – elexxion claros, is a digitally pulsed diode laser with a wave length of 810nm, which means that the laser energy is absorbed by the melanin. The claros has a pulse frequency of 20,000 Hz, with a peak power of 30W and a pulse width of 15 microseconds, with an average power of around 10 Watts. With this setting, the laser beam is “on” the tissue for only 15 microseconds, of each interval cycle of 50 microseconds (20,000 such interval cycles every second), which makes around one third of the total cycle. The rest of the time is to allow for the tissue to cool down. STEP 02 A non-initiated 600 micron fibre was used. It was ensured that all concerned are wearing 810nm specific safety glasses. The protocol asks for the clinician to start with the laser tip several centimeters away from the pigmented tissue and slowly bring it closer.

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STEP 03 Then, at around 12-15mm away, the laser was started by depressing the foot control and moving it closer until there is a visible reaction of the tissue from the laser light. This is when a slight blanching of the surface tissue can be seen. The indicative distance was maintained and the treatment was continued with simple paint-like movements, with the visible laser aiming beam penumbra (the aiming beam spot) at a reasonable speed, over the pigmented tissue, in order to get a general blanching over the entire area. The exposure time for this case was around 1 minute. The immediate postoperative result is shown in (Fig. 2), which shows the blanching of the tissue surface.

A photograph of the post-operative tissue reaction above (the left central as a close up in Fig. 3 and 4), gives an excellent view of the ‘blister’ effect. The patient described the feeling to be similar to eating a very hot soup, with a resultant blister in the mouth. This technique is not painful and as far as this patient is concerned, there was no discomfort at all.

the patient reported no trauma, feeling quite comfortable the whole time. The formal review picture shows a significant improvement over the pre-operative area (Fig. 5). Being clinically critical, there is still some pigmented tissue on the gingival margin above the central incisors. However, when the possibility for ‘touch up’ was discussed, the patient declined, explaining that this result was so significant that she was delighted and did not want to go any further with follow up treatments. It was unclear at the start what sort of relapse could be expected in a case like this (intrinsic pigmentation) and how long the result would remain stable. Whilst the absorption of the laser energy into melanin, destroying the melanocytes could be understood, the time taken for the body to rid the area of this melanin pigment was less clear. The stability of the results was reviewed on an ongoing basis and it seemed as if it was improving steadily over time. 14 months follow up At 14 months post-operatively,

more photographs were taken (Fig. 6), which shows an excellent and stable result from a single treatment lasting around 1 minute.

Unfortunately, due to family issues, the patient has returned to her native Phillipines and it is unlikely to get further post-operative pictures to demonstrate the longevity of the treatment in this case. The reasoning behind using minimal amounts of anaesthetic was to be able to assess the patient’s reaction to the treatment. Should there have been any pain, we would have aborted the treatment completely. Nevertheless, following the careful guidance from the elexxion local distributor, as well as the Area Representative, we were able to complete one atraumatic treatment, as planned. Dr. Luk suggests the use of water as a cooling method and this could also be incorporated into the technique, as there is a minimum absorption of the 810nm wavelength by water – much less than other diode wavelengths.

At a glance Fig 1 Pre-operative Fig 2 Immediate post-operative Fig 3 Immediate post-operative close-up Fig 4 Immediate post-operative detailed view Fig 5 Follow-up 3 weeks Fig 6 Follow-up 14 months

Conclusion The use of a digitally pulsed diode laser for GMP can be extremely effective and atraumatic, if it is based on the protocol described in this case study. This method can have a wide reach out in the Middle East and Asia, where an affordable, minimally invasive and comfortable procedure would satisfy the demands of many patients and I would encourage other colleagues to apply it.

Needless to say, the patient is delighted with the result and is an excellent promoter of this treatment within our clinic.

References

1. Achieving better esthetics by gingival de-pigmentation: report of three cases with a review of the literature. Parwani S, Parwani R. J Mich Dent Assoc. 2013 Feb; 95(2):52-8, 78. 2. Comparison of surgical stripping; erbium-doped: yttrium, aluminum, and garnet laser; and carbon dioxide laser techniques for gingival depigmentation: a clinical and histologic study. Hegde R, Padhye A, Sumanth S, Jain AS, Thukral N. J Periodontol. 2013 Jun; 84(6):738-48. doi: 10.1902/ jop.2012.120094. Epub 2012 Sep 24.

3. A comparison of diode laser and Er:YAG lasers in the treatment of gingival melanin pigmentation. Simsek Kaya G1, Yapici Yavuz G, Sümbüllü MA, Dayi E. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Mar;113(3):293-9. doi: 10.1016/ j.tripleo.2011.03.005. Epub 2011 Jun 12.

During this whole procedure, the patient should be quite comfortable and without any noticeable signs of pain or being in anyway unhappy with the treatment.

4. Removal of gingival melanin pigmentation with the semiconductor diode laser: Yousuf A, Hossain M, Nakamura Y, Yamada Y, Kinoshita J, Matsumoto K. A case report. J Clin Laser Med Surg 2000;18(5):263-266.

After the treatment, the healing process was discussed and the patient was advised to use chlorhexidine mouthwash twice per day

5. Clinical application of a digital pulsed diode laser in depigmentation therapy. Dr Kenneth Luk, Journal of ALD, 2005 Vol 13, Issue 4 pp18-21 6. Depigmentation of gingivae and lip with Digital Pulsed Diode Laser—an integral part of Cosmetic Dentistry, Dr Kenneth Luk, Laser Journal 2/2009 pp31-33

3 weeks follow up Clinical pictures

were taken in most of the days following the procedure. The formal review was done after 3 weeks and during the healing period

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Elexxion claros The elexxion claros laser was the first digitally pulsed laser capable of delivering the patented 20,000Hz laser beam delivery now common across the elexxion range of products. Available now as either a 50W and 30W unit, the claros is the only diode laser capable of non-surgical de-pigmentation with the fastest cutting speed of any available dental diode laser and in addition to all of the standard elexxion diode laser applications: killing bacteria in periodontal pockets; killing bacteria in endodontic root canals; laser power whitening for both vital and non-vital teeth (using elexxion Odobleach); Low Level Laser Therapy and Biostimulation; soft tissue management with full haemostasis as well as the use of the perio green photosensitiser for peri-implantitis.

Elexxion elexxion.de

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Aura

the finishing touches How SDI Aura saved the day for a college student who wasn’t happy with the results of her orthodontic treatment.

Based on the natural make-up and colors of enamel and dentin Simple layering technique to reproduce the natural colors of teeth High polishability and sculptability 1

[ Dr. Hugh Flax ] Information provided by SDI (North America) Inc.

Dr. Hugh Flax, DDS, AAACD, FICOI

While the results of orthodontic treatment usually bring big smiles and straighter teeth, there are some side effects that can go along with treatment as well. Such was the case with a recent patient. She was a college student who was about to begin nursing school and had finished her orthodontic regimen. However, she was not pleased with the results. When she looked in the mirror, she saw discolored teeth, white spots and yellowed composites, a prominent upper left canine, inconsistent shapes and papilla, and worn edges of teeth. She also complained of muscle tenderness and a sense of not having a consistent bite. It was determined that the prominent canine, slight fremitus of Nos. 6-11, and general tooth wear were indicative of occlusal dysfunction, while the discolored cervical composites and generalized “white spots” were indicative of a history of decalcification. Noting the decalcification, one of the biggest questions at her exam was whether this was still an active problem. A “bioluminescence” test demonstrated a lower than optimum pH in the oral environment. The patient was put on an aggressive remineralization program using CariFree treatment rinses and toothpastes/gels. For this case, the Aura system was used due to its durability, natural selection of colors, and its ability to allow underlying tooth structure to enhance the composite’s appearance. Some of the qualities that I appreciate about the Aura system are:

• It’s non-sticky. Less uncured resin is used, resulting in creamy handling. • It’s easy to polish to a mirror finish • It has large particles (60 microns). This means high filler loading and strength. • A big bonus is its low flexural modulus. This means better fracture resistance as less stress at the composite interface means less debonding. • It has lower polymerization shrinkage. • It is a prepolymerized microfilled composite, making it stronger than a standard microfill. • It’s easy to polish to high gloss. • It has high fluorescence in the dentin and slight in the enamel and contains opalescence (bluish glow in natural light) to match natural enamels. I think this gives life to the restoration. • It has superb gloss retention without the “plucking effect” of large particles. The patient wanted a shade that was bright but also looked natural. The Aura E1 shade was selected because it was the most whitish/lightest. It has high opalescence with some degree of translucency and was designed to emulate young enamel for those who are 20 or younger. STEP 01 Surface discolorations and previous composites were conservatively removed with a f lame-shaped diamond, maintaining the outer enamel and creating room for the forthcoming layer of Aura. STEP 02 Treatment sequence of bonding is begun with tooth Nos. 8 and 10. After outline form and gross contouring, No. 7 and No. 9 were treated in the same fashion. Tooth Nos. 5 and 6 were bonded, followed by Nos. 11 and 12. Aura’s handling properties allowed this

be performed very eff iciently and effectively.

SDI

sdi.com.au

STEP 03 37% phosphoric acid was placed over the entire labial surface with a 30-second exposure time (since no dentin was involved) and thoroughly rinsed with water for 15 seconds each. STEP 04 A universal bonding resin was placed carefully placed using a microbrush and thinned with a warm air dryer.

at a glance 1. College student (about to begin nursing school) very unhappy with her post-orthodontic results.

2. Among the problems was a prominent upper left canine.

STEP 05 Each tooth being treated was cured for 20 seconds using SDI’s Radii Plus light with its wide tip. Aura Enamel (Shade E1) was thinly applied and sculpted using Cosmedent’s Titanium IPCT Instrument, placing the gingival half first blending the interproximal. After a 40-second cure, the incisal portion is adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.

STEP 06 Gross finishing is achieved with a thin 16 bladed ET 9 bur to clean the gingival margins and establish labial anatomy. Interproximal surfaces were smoothed with plastic finishing strips.

3. Muscle tenderness and sense of not having a consistent bite, prominent canine, slight fremitus of Nos. 6-11, and general tooth wear were indicative of occlusal dysfunction. 4. Discolored cervical composites and generalized “white spots” were indicative of a history of decalcification. 5. Using the Erbium laser in soft tissue mode of 2 Watts to create a better “gingival frame” prior to bonding. 6. Surface discolorations and previous composites conservatively removed with a flame-shaped diamond maintaining the outer enamel and creating room for forthcoming layer of Aura.

Overall, she was very happy with the results and could finally flash the confident smile of completed orthodontic treatment. 6

with water for 15 seconds each. 14. A universal bonding resin was carefully placed using a microbrush and thinned with a warm air dryer. 15. Each tooth being treated was cured for 20 seconds using SDI’s Radii Plus light with its wide tip. Aura Enamel (Shade E1) was thinly applied and sculpted using Cosmedent’s Titanium IPCT Instrument placing the gingival half first blending the interproximal. After a 40 second cure, the incisal portion is adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring. 16. Gross finishing is achieved with a thin 16 bladed ET 9 bur to clean the gingival margins and establish labial anatomy. Interproximal surfaces were smoothed with plastic finishing strips. 17. Labial surfaces were polished using a series of abrasive disks.

7. and 8. Suspicious decalcifications checked with cavity detection dye

18. Final gloss achieved using a flexible felt disc and aluminum oxide paste.

9. All remaining “affected” enamel removed with the Erbium laser.

19. The patient’s confidence was soaring after her conservative care.

10. and 11. Conservative preparation of enamel surfaces.

20. Note the uniformity of color and contours that give the smile better balance and esthetic harmony.

12. Air particle abrasion with a small tip (27 micron Aluminum oxide; 40 psi) has been shown to greatly enhance the shear bond strength of materials to enamel and dentin. 13. 37% phosphoric acid was placed over the entire labial surface with a 30 second exposure time (since no dentin was involved) and thoroughly rinsed

21. Greater esthetic brightness and occlusal harmony are evident intraorally. 22. Gingival health and soft incisal anatomy are welcomed outcomes in this case.

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technique

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Simplify the direct restorative process

at a glance 1. The patient presented with a failing composite restoration on tooth No. 13 and primary caries on tooth No. 12. 1

2. Restoration removal and caries excavation were performed on both teeth.

Using a universal adhesive with multiple composite resins from Ivoclar Vivadent for great clinical results.

3. A single-component adhesive (Adhese Universal) was scrubbed into the tooth surface for at least 20 seconds to tooth No. 12.

[ By Dr. Ronny Watzke] Information provided by Ivoclar Vivadent.

4. The adhesive was light cured with a LED curing light (Bluephase Style) for 10 seconds.

Dr. Ronny Watzke

advancements in direct restorative

materials are not limited to composite resins. Innovations in dental adhesion science have also had a substantial impact on direct restorative procedures.1 Dental adhesives are used for a myriad of clinical applications that are not limited to direct composite restorations, though it is there that their impact is crucial.2 Direct composite resin restorations today are virtually indistinguishable from a patient’s surrounding natural dentition, providing a significant esthetic advantage that contributes to their popularity and placement frequency. 3,4 Because direct composite restorations are now an integral part of restorative dentistry, clinicians should have an extensive knowledge of the properties, indications and clinical performance of both composite resins and dental adhesives.5 It is often a combination of these materials that achieves the desired outcome, particularly when multiple restorations are placed.

Complementary composite systems A direct composite placement approach using multiple components is ideal when patients present with several clinical issues that require different preparations and restorations. A flowable composite (Ivoclar Vivadent’s Tetric EvoFlow) can be used as a liner

with other composite resins, or on its own, as it is non-slumping and easily contoured in Class III and V restorations. It is a flowable yet highly stable composite available in multiple shades to achieve ideal esthetics. The material’s innovative Viscosity Controller ensures that this f lowable composite is evenly distributed throughout the preparation to prevent voids. A nano-hybrid composite resin (Ivoclar Vivadent’s IPS Empress Direct) can be used for anterior and posterior restorations for which a flowable composite is not sufficient. Light-curing and extremely esthetic, this composite is available in 32 shades and five levels of translucency, according to the manufacturer. It is less sensitive to light, providing clinicians with a longer working time to sculpt and design the restoration to full contour. It also demonstrates a high radiopacity, enabling clinicians to easily differentiate between natural dentition and restorations on radiographs, allowing for easier detection of secondary caries.

A universal adhesive Although successful treatment may require more than one direct composite resin, clinicians can save time by employing a universal adhesive system (Ivoclar Vivadent’s Adhese Universal) for all restorations. Adhese Universal is a single-component, light-curing adhesive indicated for both direct and indirect restorations. Because the system is compatible with all etching techniques (e.g., self-etch, etch and rinse, selective-enamel-etch), clinicians are not limited to specific adhesives for

certain techniques; instead, they can select the technique appropriate for individual restorations and use one adhesive. The adhesive also reduces instances of post-operative sensitivity because, according to the manufacturer, all dentin surfaces are effectively sealed with its use. The following case presentation demonstrates the capabilities of this universal adhesive, even when used with different composite resins, to successfully restore a patient’s dentition.

5. A direct composite (Tetric EvoFlow A2) was placed in the preparation. 6. The composite material was contoured. 7. Approximal polishing with Sof-Lex Discs (3M ESPE) was performed. 3

8. A sectional matrix system was placed to isolated tooth No. 13. 9. The enamel preparation of tooth No. 13 was etched for 15 seconds. 10. The entire cavity preparation was etched for an additional 15 seconds.

Case presentation The patient presented with a failing composite restoration on tooth No. 13. STEP 01 Upon examination, primary caries were also discovered on tooth No. 12 (Fig. 1). After discussing treatment options with the patient, it was determined that direct composite restorations would be appropriate and provide a conservative treatment. A flowable composite (Tetric EvoFlow) and an esthetic composite system (IPS Empress Direct) would be placed in conjunction with an all-purpose adhesive (Adhese Universal) to meet of all the patient’s esthetic and clinical requirements.

11. The etchant was rinsed and the tooth air dried.

12. Adhese Universal was scrubbed into the mesial cavity of tooth No. 13 for at least 20 seconds. 13. Adhese Universal was scrubbed into the distal cavity of tooth No. 13 for at least 20 seconds. 14. The adhesive was dispersed with air until a glossy, immobile film layer resulted.

15. The adhesive was light cured for 10 seconds.

material in shade A3 Dentin (IPS Empress Direct) was placed . 18. The composite material was sculpted and contoured.

Adhese Universal Single adhesive for all materials and techniques

19. Composite material in shade A2 Enamel (IPS Empress Direct) was applied to the preparation.

· High bond strength and virtually no post-operative sensitivity · Available in the revolutionary VivaPen

20. The marginal ridges of tooth No. 13 were mesial and distal sculpted.

Ivoclar Vivadent ivoclarvivadent.com

21. The matrix was removed. 22. Another layer of the composite in shade A2 Enamel (IPS Empress Direct) was placed to shape the occlusal area 23. A contouring instrument (OptraSculpt Pad) was used to shape the composite material. 24. Empress Direct Color in shades ochre and brown was applied to enhance the natural appearance of the restoration. 25. The restoration was pre-polished with a polishing system (Astropol F).

26. The restoration was then polished approximal with Sof-Lex Discs. 27. Clinical situation before removing the rubber dam. 28. The occlusion was checked. 29. Adjustments were made to correct the patient’s occlusion. 30. The restoration was finally high-gloss polished with an additional polishing system (OptraPol Next Generation). 31. The restoration was finally highgloss polished with an additional polishing system (Astrobrush). 32. The occlusion was verified. 33. Post-operative view of the final restorations (one week after placement).

16. A flowable composite (Tetric EvoFlow A2) was applied to the preparation. 17. A nano-hybrid composite 6

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technique

STEP 02 Teeth were isolated using rubber dam (Ivoclar Vivadent’s OptraDam Plus).The failing restoration was removed, and caries excavation was performed on both teeth (Fig. 2). STEP 03 A single-component adhesive (Adhese Universal) was scrubbed into the tooth surface for at least 20 seconds to tooth No. 12 , then light cured with a LED curing light (Ivoclar Vivadent’s Bluephase Style) for 10 seconds (Figs. 3 and 4).

STEP 11 A characterization mater ia l (Ivocla r Vivadent’s IPS Empress Direct Color) was applied in shades of ochre and brown to add tints and enhance the natural appearance of the restoration (Fig. 24). 28 18

STEP 12 The material was light cured for 20 seconds, and the restoration was then pre-polished using various polishing systems (Ivoclar Vivadent’s Astropol F; 3M ESPE’s Sof-Lex) [Figs. 25-27] .

STEP 04 A flowable composite (Tetric EvoFlow A2) was directly applied to the preparation, contoured, and light cured (Figs. 5 and 6). Though a flowable composite material, Tetric EvoFlow is non-slumping and remains easily contoured without forcing clinicians to work quickly before the material runs.

STEP 07 After the etchant was rinsed and the tooth air dried for 5 seconds (Fig. 11), Adhese Universal was scrubbed into both the mesial and distal cavity of the tooth for at least 20 seconds (Figs. 12 and 13). The adhesive was then dispersed with air until an immobile layer developed (Fig.14) and light cured for 10 seconds (Fig. 15). STEP 08 Tetric EvoFlow in shade A2 Dentin was then applied as a liner to the preparation and light cured for 10 seconds (Fig. 16). Though it can be used on its own for restorations such as the one for tooth No. 12, this flowable composite is also designed to supplement other composite restoratives for other classes of restorations. Therefore, a nano-hybrid composite material in shade A3 Dentin (IPS Empress Direct) was placed, sculpted, contoured and light cured for 20 seconds (Figs. 17 and 18). STEP 09 Composite material in shade A2 Enamel was then applied mesial and distal approximal to sculpt the marginal ridges and light cured for 20 seconds (Figs. 19 and 20).

STEP 13 Occlusion was checked and adjustments were made (Figs. 28 and 29). The restoration was then finally high-gloss polished with additional polishing systems (Ivoclar Vivadent’s OptraPol Next Generation; Astrobrush) and the occlusion was verif ied, (Figs. 30-32). The patient was very pleased w ith the outcome (Fig. 33).

STEP 05 The restoration was then polished with polishing discs (3M ESPE’s Sof-Lex) [Fig. 7]. STEP 06 A sectional matrix system was placed to tooth No. 13 (Fig. 8). The enamel preparation was etched for 15 seconds (Fig. 9), and the entire cavity preparation was then etched for an additional 15 seconds (Fig. 10).

About the author Dr. Ronny Watzke is head of the dental clinic of Ivoclar Vivadent`s research and development department. He is responsible for the clinical studies concerning prosthodontics, implantology and geriatric dentistry. He is an author of several publications (particularly all-ceramics and post-and-core restorations), member of the review board of the Journal of Adhesive Dentistry and lecturer for ITI. He started his career at the Humboldt - university in Berlin (1999-2006), where he was assistant doctor at the department of Prosthodontics of the Virchow-clinic (Charité) after he passed the examination with distinction in 2004.

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Conclusion

It behooves dentists to carefully select the appropriate composite resin based on clinical indications, as not all cases or restorations require the same materials. However, a universal adhesive can simplify the direct restorative process, benefiting clinicians and patients alike.

References

1. Perdigao J, Lopes M. Dentin bonding state of the art 1999. Compend Contin Educ Dent 1999;20(12):11511162. 2. Latta MA. Recent advances in dental adhesives-part 1. Inside Dentistry. Retrieved online at https://www.dentalaegis.com/special-issues/2010/06/ recent-advances-in-dental-adhesivespart-i. 3. Stein PS, Sullivan J, Haubenreich JE, Osborne PB. Composite resin in medicine and dentistry. J Long Term Eff Med Implants. 2005;15(6):641-654. 4. Minguez N, Ellacuria J, Soler JI, Triana R, Ibaseta G. Advances in the history of composite resins. J Hist Dent. 2003;51(3);103-105. 5. Sensi LG, Strassler HE, Webley W. Direct composite resins. Inside Dentistry. Retrieved online at http://www.dentalaegis.com/id/2007/08/direct-compositeresins.

25 32

STEP 10 The matrix was removed (Fig. 21), and another layer of the composite in shade A2 Enamel was placed to shape the occlusal area using a contouring instrument (OptraSculpt Pad) [Figs. 22 and 23], then light cured for 20 seconds.

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tech brief

Applying Planmeca PlanScan in your practice

tech brief

Applying SmartLite Focus in your practice ®

A closer look at this new pen-style LED curing light. A closer look at this ultra-fast intraoral scanner for open CAD/CAM.

[ Compiled by Stan Goff ]

Information provided by DENTSPLY Caulk.

Information provided by Planmeca CAD/ CAM Division E4D Technologies.

The SmartLite® Focus pen-style LED curing light from DENTSPLY Caulk is designed to ensure reliable curing all the way to the floor of the proximal box, the most vulnerable interface in a Class II restoration. Add easy one touch operation, a lightweight design, and optimal intraoral control and clinicians can expect to experience simplicity and dependability.

The Planmeca PlanScan, driven by E4D Technologies, is described as an innovative, technologically advanced, ultra-fast intraoral CAD/CAM system for restorative dentistry. With video-rate scanning and Thunderbolt™ connectivity to your Planmeca PlanCAD® laptop, Planmeca PlanScan captures and processes data almost as quickly as you move your hand – even with full-arch cases. easy to usE: Everything about the Planmeca PlanScan makes restorative dentistry quicker and easier–from intuitive computer-guided image capture to plug-and-play technology that gives you the freedom to scan at multiple Planmeca PlanScan workstations. Additionally, it’s powder-free. Optimal accuracy: It’s the only intraoral scanner in the world with blue laser technology. Its smaller wavelength (450 nm) is more reflective, resulting in sharper images. Its ability to capture fine details allows for more clinically precise prosthetics. added plus: The new scanner and new open CAD software suite for easy 3D design, Planmeca PlanCAD™,

uniform performance: Many lights

is integrated within the Planmeca Romexis® software and is a perfect tool for designing prosthetic works from individual inlays to full-arch bridges and abutments. For practitioners who place implants, the Planmeca Romexis software enables them to import data needed for treatment planning from another system, whether or not it is Planmeca’s. Users of Planmeca Romexis software can now share images (2D and 3D) and documents with minimal effort via a Planmeca Romexis Cloud. Information is securely transferred into the cloud and the recipient is automatically notified of new cases requiring his or her attention.

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Are you ready to apply this technology in your practice? Planmeca CAD/ CAM Division E4D Technologies e4d.com

deliver less than 35% of their stated energy output to the f loor of a deep proximal box, but not SmartLite ® Focus. Its collimated light beam reduces light divergence to deliver adequate light energy for curing material 8mm away – the clinically relevant distance light must travel for a reliable, solid cure on an average Class II restoration. Optics ensure a homogenous beam profile for uniform performance in the curing area.

“automatic quick charging mode” for 5 minutes of cure time with just a 10 minute charge, “standard charging mode” to achieve a full charge in less than 3 hours, and “standby mode” which prevents overcharging when not in use. The SmartLite Focus Replaceable Battery Pack offers stable energy output even after prolonged storage. added plus: With single-button simplicity for a 20-second curing cycle, and ergonomic design, the curing light promotes consistent use across operators.

Are you ready to apply this technology in your practice?

great access: The newly designed light probe maximizes intraoral access by providing a 7.5 mm diameter tip that can swivel 330° to achieve proper position anywhere in the mouth. Also, it weighs only 90g. easy charging: Smart Recharge Technology checks the battery conditions and initiates the proper charging mode:

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DENTSPLY dentsplymea.com

AUGUST 2014

clinical &techniques

tech brief

solve my problem

Applying Sapphire Plus in your practice [ Compiled by Dental Arabia Middle East ] Information provided by DenMat.

The Problem: Crowns not seating properly

Solution: No waste at all and happier patients

“I’ve had a problem with crowns being high. [I’ve had] to do adjustments for a period of time and I have been talking to the lab about it,” Dr. Hollis said. “It’s very frustrating when you feel like you’ve done everything you can possibly do to give the lab what they need, and you get a crown back and it’s high, or you know you need to spend time adjusting.”

In addition to better fitting crowns, Dr. Hollis loves the waste-free delivery tips and her patients enjoy the faster setting times and better tasting material. “The patients definitely notice a difference,” Dr. Hollis said. “What we were using before has a bitter taste and a longer setting time. The consistency of this material is really nice. It’s not runny. It’s great. It’s exciting to have a material like this.” Another benefit is the delivery of the material. “With a lot of the systems, there can be a waste of material with the syringes,” she said. “There’s no waste with this. You have the little carpule and you’re done, rather than our assistants filling up a full syringe of material for one tooth. With this system, there is no waste.”

Solution: Change the system Sapphire Plus generates and delivers maximum curing and whitening power to the restoration with the new Power Conversion Technology. This power train forms a coherent beam of light for the fastest curing and hardest composites no matter the distance. It can be used for both teeth whitening and composite cuing. TEETH WHITENING: With easy and safe patient set

up, the Sapphire Plus is proven to whiten teeth up to 86% more than just whitening gel alone. The greatest whitening is achieved with the LUMIBrite Chairside Whitening System, gently whitening in 30 minutes or less.

solutions to everyday problems

COMPOSITE CURING: Sapphire Plus delivers the

greatest total energy in just 5 seconds to produce the hardest top and bottom restoration surfaces. LUMINEERS PLACEMENT: With the Sapphire plus curing light LUMINEERS can be placed up to 50% faster than when using a standard curing light. ADDED PLUS: Different diameter curing tips are available for maximum control over the curing process.

How one clinician is using Dentsply Caulk’s Aquasil Ultra Cordless impression system to solve problems. [ By Stan Goff ] Are you ready to apply this technology in your practice? Denmat denmat.com Distributed by Zabadne Sterling Dental Exclusive Distributor for Denmat products in GCC, M E, Africa, CIS and Turkey lumineers.me

AUGUST 2014

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When Dr. Mary Ann Hollis started having some problems with her crowns not seating properly, she began to experience some stress and even began to wonder if her current laboratory was not doing a great job. But when Dr. Hollis, one of the owners of Grove Dental Associates in the western suburbs of Chicago, switched to the Aquasil Ultra Cordless Tissue Managing Impression System, her crowns started to fit like a glove. She has also noticed other benefits from using the system and made plans heading into the Chicago Dental Society Midwinter Meeting to stock up on the relatively new product.

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“The only thing I’ve done differently is change to this system,” said Dr. Hollis, who was an early beta tester of the Aquasil Ultra Cordless System. “Now [the problem] has gone away. I talked to my lab, and that’s what I figured out. I called them earlier and I wrote a letter, and they just asked: ‘How is it going for you?’ And I was thinking Wow, now these crowns are dropping in.” Dr. Hollis had asked the owner of her lab if he had noticed any differences in the cases she was sending along since she made the switch to the Dentsply Caulk system. “I said, ‘Did you notice a difference in the material working for you?’ He said, ‘Absolutely.’ And then he added that everything is great,” Dr. Hollis recalls. “We talked and I said the only thing I’m doing differently is using the Aquasil Ultra Cordless System. It’s more accurate than what I was using before. Now I’m not adjusting and the crowns are dropping in. Also, [the lab] told me they’re able to scan it and it’s more accurate, and they feel it’s more accurate than having to pour up a model.”

Conclusion Dr. Hollis loves the new system from Dentsply Caulk and plans to recommend the product to the other locations that are part of Grove Dental Associates. She works out of the Lombard, Ill., practice, but the group also has three other locations. “I really would bring this to the rest of the owners and say ‘you’ve got to see this,’” she says of the Aquasil Ultra Cordless System. “I think it’s a cost saving too. You have less chairtime and less waste.” One other important bonus is the confidence the product can deliver. “There’s less stress knowing that my crowns are going to come back and fit just right,” she said.

The Problem: Wasted material and patient discomfort

AUGUST 2014

PRODuCTS IN PRACTICE

Is your practice ready for Autism? As the number of children diagnosed with autism continues to grow, it’s important for you and your team members to know what products to avoid and what products work best when treating patients on the autism spectrum in your practice.

Shirley Gutkowski, RDH, BSDH

Autism is a fact of life for many fami-

lies who come to your dental practice. What does that mean for your practice and, more importantly, what products can be used safely in patients who are considered toxified or are cured but are still sensitive to product choices and ingredients commonplace to the practice of dental hygiene? Most importantly, we need to know about autism treatments. There are two product categories that families avoid if someone in the family is on the autism spectrum: gluten and dairy. Products like Young Dental’s D-lish prophy paste (youngdental.com) and other glutenfree polishing pastes are great options for patients with autism. Dairy-free remineralization ingredients are also great. Products like VOCO’s Remin Pro (voco.com), which contains hydroxyapatite molecules are well received, as are products containing NovaMin.

Fluoride considerations Low-level topical fluorides may be well received or at least better received than products with high levels of fluoride. Triage sealant material is a must-have as it promotes enamel healing, acts as a physi-

“

Start to gather intel on Autism Spectrum Disorder and how autism is successfully treated today. ...Look for products that fit the sensibilities of these families and you my find a wonderful way to treat all families.”

PRODuCTS IN PRACTICE

protocol

(phocaltherapy.com). Highly specific discs are just 3 mm in diameter and can be placed with very little drama at any appointment, preventive or prosthetic. Because of its extremely pinpoint location, the fluoride given via phocol discs may be better received than a general fluoride treatment. It can be explained as an isolated treatment for a tenuous condition on a single tooth or area.

too, however that shows only enamel breakdown, not the quality of biofilm accumulation.

What is Autism? Autism spectrum disorder (ASD) and autism are general terms for a group of complex disorders of brain development, according to autismspeaks.org. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.

Did you know...

Become more educated

Autism now affects 1 in 88 children. yCollident’s Phocal fluoride disks are thin, round and can be effortlessly inserted between a patient’s teeth to deliver a concentrated dose of fluoride to formerly inaccessible areas.

Non-fluoride options Fluoride may be a difficult sell to families with children on the autism spectrum, and that means non-fluoride options better be high on your practice’s protocol development list. Xylitol products are fantastic for this group of patients. They can tolerate the all-natural plant-based xylitol. There is some misinformation on the Internet that may keep some from using xylitol products. Become educated on all sides of the xylitol story by visiting xylitol.org. Some parents may lean toward stevia, for instance, as a natural sweetening option. While great as

Start to gather intel on Autism Spectrum Disorder and how autism is successfully treated today. My radio broadcast, The Autism Experience on Cross Link Radio, is a good starting point. Look for products that fit the sensibilities of these families and you may find a wonderful way to treat all families. About the author

an ingredient or additive for hot or cold drinks, there are few studies on stevia and oral health/dental decay. Erythritol is another story! Truvia is nearly all erythritol. As another sugar alcohol, erythritol has some interesting studies showing dental benefits, although xylitol is still the go-to sugar for dental health. Source: Autismspeaks.org

The benefits of fluorescence technology Radiation is always going to raise a red flag to those who are trying to remain or regain health. Low radiation is not as good as no radiation. Fluorescence technology can really set minds at ease and allow clinicians to gather more data than they could from traditional radiographs. Transillumination is an option,

Shirley Gutkowski, RDH, BSDH, is the author and publisher of The Purple Guide series of books for dental hygienists. She is also the host of the popular daily radio podcast on Blog Talk Radio and Stitcher: Cross Link Radio. Gutkowski is also a faculty coach at CAREERfusion. She can be reached for speaking or consulting at crosslinkpresent@aol.com.

PORTION CONTROL yRemin Pro from VOCO is a protective cream that helps strengthen, remineralize and desensitize teeth.

Maintaining expenses is all about divvying things up correctly. Compiled by t h e

pride institute

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3–5% Promotions 5–7% Dental supplies

<10% Discretionary expenses

It’s difficult for a dentist and team to visualize the true impact expenses have on the practice’s potential success. There seems to be a disconnect between what the practice produces and what can and should be left on the bottom line as profit. The best way to explain the relationship is to think about Production and Collections per month and year as a giant chocolate cake. The ingredients that go into the cake include: scheduling, financial arrangements and collections, marketing, new patient processes, continuing care, technology integration and much more. Expenses eat away at the cake, so you need to be sure there are enough slices to feed the team, vendors and provide nourishment for the dentist as well. The visual at right presents expense range norms as calculated by Pride averages.

cal barrier and has none of the issues traditional fluoride varnishes, smart varnishes, and most resin sealant materials have. Those issues include either potentially toxic levels of fluoride, potential ingestion of fluoride, pine resin base, or Bisphenol A, which is found in some resin products. Glass ionomers have nearly medicinal properties, and may be used as temporary filling material in frank, open, and incipient lesions. P rox i m a l le sion s on adj ac e nt teeth may be repaired using Phocol f luor ide disk s f rom Col ldent

AUGUST 2014

protocol

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5–7% Facility expenses 10–12% General and administrative costs

22–38% Employee expenses

10–14% Lab costs

25–45% Owners’ compensation for general practitioners (more like 35–55% for specialists)

AUGUST 2014

PRODuCTS IN PRACTICE

MARKETING

Improving telephone skills can pay off big Examining existing internal processes can improve your marketing ROI without additional costs. [ By Naomi Cooper | President, Minoa Marketing and Chief Marketing Consultant, Pride Institute ]

naomi cooper

creasing new patient flow ... it’s a common goal among dental practices across the country. Marketing is certainly an important component when trying to reach new patients; however it is not only about throwing money at a flashy new campaign. Dental practice marketing encompasses the entire patient experience, from the first time potential patients hear about the practice to when they are in the chair, and even after they leave.

Spending precious funds on external marketing in the hopes of making the phone ring can actually be a waste of money if calls from prospective new patients callers aren’t currently being properly handled. Dentists can benefit from an improved marketing ROI simply by taking a closer look at one very important component: the new patient phone call. It is critically important that everyone on the front desk team has exceptional verbal skills. After all, they are essentially the welcoming committee for the practice. The initial phone call is one of the first interactions new patients have with the practice. When a potential patient calls the practice, the conversation AUGUST 2014

should not be left up to chance. Patients need to feel taken care of and to believe in the practice from the very first point of contact.

The Initial Phone Call The front desk team needs to properly establish a good rapport during the conversation, so one key thing to remember is to ask open-ended questions. At the end of the day, asking “yes or no” questions – and providing one-word answers to your patients’ questions – simply doesn’t facilitate positive, open communication.

When speaking with a potential patient looking to schedule their first appointment, instead of offering a specific date and time to determine how to meet your need to fill the schedule, as in “How is Friday at 11 a.m.?” the goal is to get the patient to open up. Asking questions such as, “Do mornings or afternoons work better for you?” not only gives the front desk team further insight into the prospective patient’s lifestyle, but says to the patient that the practice is not just trying to fill the schedule, but rather is interested in setting appointments that are most convenient for their patients. When it comes to answering questions from prospective patients, remember that these are patients who don’t know you or the doctor yet, so how your response subjectively establishes the patient-practice relationship is just as important as the objective answer that you provide. So when patient callers ask about prices or insurance benefits, realize that what they are truly wondering is whether they can trust the dentist and the team and if they are going to be dealt with fairly, honestly and with care. In this case, rather than judging the caller for “shopping” or conversely, instantly responding by quoting the fee schedule, take the opportunity to win the patient over with a response like this: “Mrs. Patient, you made the right choice calling our practice. Dr. Friendly is an amazing dentist – all of her patients love her and I know you will too. Rest assured that we will always inform you of any costs before we perform treatment and will work with you to maximize your insurance benefits. The fees for this service in our practice vary anywhere from X to Y based on the complexity of your case -- I know the doctor would be very concerned about your problem and would want me to make sure she sees you as soon as possible. Would you prefer tomorrow at 3 p.m. or Wednesday at 9 a.m.?”

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Two Options for Tracking Measuring the verbal skills – and conversion skills – of the front desk team is essential. This can be accomplished one of two ways: 1. Do It Yourself or 2. Outsource.

Getty Images / Jamie Grill

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AUGUST 2014

PRODuCTS IN PRACTICE

Option 1 - DIY The lower cost of the methods, the Do-It-Yourself option, can be implemented immediately. It comes down to simply tracking every new patient phone call that comes into the practice on a daily basis. The DIY method tracks the source of new patient phone calls, determines the conversion rates of new patient calls to those that actually appoint, as well as the effectiveness of the front desk team’s communication skills. The tracking system can be as simple as taking a sheet of paper with columns designated across the top for: Name of Caller; Reason for Calling; Source (how they heard about the practice); Phone #; Email Address; and Notes. With every prospective patient phone call that comes in, be sure all fields are filled in. However, while the objective is to gather this information, it must be done in a friendly and conversational manner. The front desk should introduce themselves and reassure the potential patient they’ve called the right place. Name: “You’ve made the right choice calling Dr. Friendly’s office. All of her patients love her and I know you will too. I’m <insert name>. Who am I speaking with?” Right away the front desk team has established a relationship while gathering the information. Reason: “What is the primary reason for your call today?” This helps establish the patient’s immediate need and any urgent concerns. Source: “Many of our new patients come to us as a referral from existing patients. Who can we thank for referring you?” Now the team has established that the existing patients feel strongly enough about the practice to send their friends and family. If the referral source is a marketing campaign, the new patient will provide that as an alternative answer to the question. And finally, getting the potential new patient’s phone number and email address can be difficult as people do not always feel comfortable sharing. Working it into the conversation may yield more positive results. Cell phone: “Before we get too far along, many times our patients are calling from their cell phones. In case we get disconnected, what would be the best number to reach you?” Email address: “We would like to send you some additional information about the practice. So that the doctor and I can follow up with you, can I have your email?” Now, as a result of a meaningful first conversation, you know the potential patient’s name, reason for calling, the marketing source and their contact information. These are important pieces of information that will shed light on what external marketing campaigns are working, and done comfortably while developing a relationship. Now is the time to address the initial reason for the call, and the probability the caller will appoint has increased given the rapport already established. It is important to note: it is necessary to address the reason for the call. But with training, the front desk team should be able to listen for the reason, while deferring the

on this MARKETING

conversation for a short time in order to take control of the conversation and establish rapport. The tracking sheets won’t do any good if the information collected isn’t regularly reviewed. Of the calls that were entered in the sheet, highlight those callers that made an appointment. And then distinguish if those who made the appointment actually showed up. This simple tracking sheet is a real gold mine: }} Which marketing initiatives result in potential patient calls, and of those callers, which marketing initiatives result most in appointments? }} Of the callers who don’t appoint, is there a single theme consistently? }} Which front desk team members convert most callers into appointments? }} Of the callers who showed up for their appointment, did a majority come from a specific marketing effort?

Option 2 – Hiring a Vendor The second option to improve your team’s phone skills would be to use a vendor that tracks call sources and records calls, enabling the doctor, office manager or practice management consultant to listen to calls after the fact. When hiring outside vendors it is always important to work with companies that have proven success in the dental industry. Sesame Communications’ First Call and My Doctor Calls are both trusted dental industry resources with similar features and capabilities, simplifying and automating front desk call recording and tracking. With these outsourced services, all incoming calls are recorded, so dentists may take the time to monitor and review each call or a subset of all calls, checking not only the communication skills of the staff, but also listening for common questions patients ask and how they heard about the practice. Vendors can also assign a dedicated phone number for each marketing campaign, which allows you to see where each call originated from (whether it be from a website, print advertising or online marketing), providing concrete data as to which campaigns are generating a positive ROI. Dentists have the opportunity to listen in to each conversation and analyze what employees are saying and where improvements can be made. It could quite possibly turn out that an increase in marketing expenditure is not always necessary. If a few tweaks can be made to the front desk team’s communication tactics, they can better handle the calls that are already coming in. Taking a close look at all the processes occurring in the practice not only makes dentists better leaders, but it will help the practice run more efficiently, and works to maximize the time, money and effort directed to all marketing efforts.

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