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11/26/2017
1
Beautiful Smiles…
Todd Snyder, DDS, FAACD, FIADFE
..with Composite Bonding
Accredited, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Former Faculty, UCLA Center For Esthetic Dentistry
Faculty, Esthetic Professionals
CBDO, Contentactivator.com
CBDO, Blux.com
Todd Snyder, DDS, AAACDLaguna Niguel, CA
Aesthetic Dental Designs®
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▪ All the work shown is my own and unaltered
Catapult Education is the only dental CE provider that integrates clinical
expertise, management effectiveness, and growth strategies to support thriving
practices.
• Many of Dentistry’s Most Trusted Educators
• Practical, Actionable CE That Helps Practices Grow
• Reviews & Leading Edge Topics
• Simple Online Education Format & Live Events
• How To Get More Cases• Photography is Critical for cases & self evaluation• Adhesion• Preparation Designs• Cases, Tips & Materials• Texture & Polishing• Business Tips• Software Products• Getting More Cases..
• a d d fadf jas
Key Points -
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According to the American Academy of Cosmetic Dentistry 50% of patients are unhappy with their smiles and 3 out of 5 people will invest in their smiles.
WHITENING
Immediate Call to Action Motivator
Start Here
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Over-the-Counter Teeth
Whiteners: $1.4 billion
(MSNBC) ...
(Consumer Reports).
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Whitening
Opalescence GO!• Fast, Easy, Effective, Better
Experience• Convenient & affordable
professional whitening to GO• Pre-loaded, disposable UltraFit™
tray for a custom-like fit• Molar-to-molar coverage• No chair time
6%, 10%, 15% Hydrogen Peroxide w/ PF.
Peach, Mint, Melon Flavors
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Opalescence Go Sample Tower
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WHITEN FIRST
Website/Internet/SEO
Social Media
Personal Case Books
Office Displays
Referral Cards
Gift Cards
Custom Smocks & Bleach Kits
Invest in technology.
-Office iPad
-Camera
-Lobby Television
-Software
Modern Tools**
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Dedicated Website Landing Page
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Be VISIBLE!!
• Market to people that want bonding.
• Have your website company build a single page that is specific and optimized for Cosmetic Dental Bonding
• Show before and aftercases
• Provide a brief description of what can be done.
Cosmetic Alterations
• How many of you want to buy something sight unseen?
• How many of you want to experience something first before investing?
• Your patients are no different!
• They are concerned about how it will look and feel. They want to be excited and happy!
• Don’t Just Tell…..Show & Tell!
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Overall Feel
Appearance…what is it? who decides, Dentist? Ceramist? Patient? Combined effort?
THEIR DECISION √
Diagnosis & Treatment Planning
The Key to Success:
VisualizationWhat is the patient’s perception or desired outcome in their mind?
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SHOFU EYESPECIAL CIII
EYESPECIAL C-II (SHOFU)
• Designed for dentistry
• 8 modes
• 12 Megapixels
• Dental cropping and grid lines
• Large LCD touchscreen
• Water and chemical proof
• Durable rugged Exterior***
• Fast autofocusing & anti-shake capabilities
• Held with one hand – weighs only 1lb
• Compatible with the Eye-Fi X2 card – Immediately upload
images onto PC, iPad, Tablet or Smartphone
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MAGNIFICATION RANGE• Chose the magnification ratio/range by rotating the dial key
• Icons to help you determine and select the range properly
STANDARD MODE
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EDIT & DRAW FUNCTION ON THE
EYESPECIAL C-II
• Edit functions are ideal for
patient education
• Under the Menu key you can:
• Draw on images to show
areas of focus
• Rotate the image
• Protect the image against
being deleted
WHITENING MODEFOR SHADE COMPARISON BETWEEN BEFORE AND AFTER WHITENING
• Similar to “Low-glare” mode but with lower light intensity
• Reduces glare and emphasizes the surface texture and shade
• Delegated Whitening & Imaging Assistant
Upper arch whitened
Lower arch not whitened
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ISOLATE SHADE MODEFOR OPTIMAL SHADE MATCHING
Quadrant Dentistry
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Cosmetic Dentistry
Cosmetic Dentistry
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• Additional Products
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SHADE SELECTION
What do they want or envision?
Look at books or imaging together
Bring in examples of smiles
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Everyone has an opinion & priorities
How WHITE?
Translucency?
What Texture?
Color Transitions
Overall Feel Motivation
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When you hand a Cosmetic Imaging to your patient, you plant a seed of what is possible, a constant reminder of what their potential new smile can be. They can show it to their friends and family, you can put a copy in their chart for follow-up, have them hang it on their refrigerator...!
Why Does this Work?
•Creates awareness
•Suggests the possibility
•Promotes discussion
•Provides bridge to clinical evaluation and
presentation of options
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The Key to Success:
Traditional Veneers
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Diagnosis & Treatment Planning
The Key to Success:
Traditional Veneers
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You are selling the Emotion…
Do you know the outcome…
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Elective Orthodontic Procedures
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Handpiece Lubricants
Long term failure occurs at gingival margins and adhesive interfaces.
Yiu CK, Hiraishi N, King NM, Tay FR. Effect of dentinal surface preparation on bond strength of self-etching adhesives. J Adhes Dent. 2008 Jun;10(3):173-82.
Higher bond strengths when using tungsten carbide burs with SE adhesives
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Preparation• Limited to removal of pathology with the exception of access and bevels.
• Maintaining enamel and superficial dentin
• Rounded line angles
• Purge hand piece oils
• Bur Choice
Disposable Single Use Diamonds
Disposable Single Use Operative Diamonds
TEXT “DIAMOND3” TO (770)212-2090
FREE!!
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Total etch Self etch# of
components
Etchant
Primer
Adhesive
The Bonding Agents
Generation4th 5th 6th 7th
Universals
OR
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Total-Etching
Bonding to Enamel/Dentin
Self-Etching
Bonding to Enamel/Dentin
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Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process - Self-Etching
Dentin fluid
Use Carbide Burs Large layers inhibit acidic monomers
Duration of exposure& acidity
Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process - Self-Etching
Dentin fluid
Self-etching adhesiveUse Carbide Burs Large layers inhibit acidic monomers
Duration of exposure& acidity
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Dentin
OdontoblastDentinal tubule
Smear layer
Adhesion process - Self-Etching
Dentin fluid
Self-etching adhesiveUse Carbide Burs Large layers inhibit acidic monomers
Duration of exposure& acidity
Adhesion process - Self-Etching
No Post- Operative Sensitivity
Excellent sealing and desensitizing
FixingOdontoblast
Sealingthe DentinHybrid layer
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Composite
Adhesion process - Self-EtchingBonding
Excellent sealing and desensitizingFixing
Odontoblast
Sealingthe DentinHybrid layer
Factors that compromise bond durability in restorative dentistry
“The major shortcoming of contemporaryadhesive restoratives is their limited durability in vivo.”
alarming
words …
but
the
reality
we
face
should
trigger
alarm
Hydrophilic dentin bonding (1956 - )
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Factors that compromise bond durability in restorative dentistry
Hydrophilic dentin bonding (1956 - )
We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong
direction
Water sorptionPolymer swelling
Decline in mechanical propertiesLeaching of hydrolyzed resin components
Factors that compromise bond durability in restorative dentistry
Hydrophilic dentin bonding (1956 - )
Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially disappeared after 6 months of
intraoral function
Instability of hybrid layers- problem may be more severe than we realize
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Factors that compromise bond durability
Hydrophilic dentin bonding (1956 - )
MMP-8MMP-2MMP-9
Demineralizing dentin is like openingthe Pandora’s box, releasing
endogenous enzymes (Matrix Metalloproteinases - MMPs)
that were trapped withinthe mineralized dentin matrix.
In the presence of water (such as thatderived from water sorption or from
adhesives, MMPs (2,8 & 9) can breakdowncollagen fibrils that are not protected
by intrafibrillar minerals
Sukala et al. (2007)Mazzoni et al. (2007)
Bond Degredation
• Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011 Sep;32(7):60-4, 66.
Resin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months.
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Without
chlorhexidine
With
chlorhexidine
as a MMP
inhibitor
Chlorhexidine prevented degradation of hybrid layers created by
Prime&Bond NT after 12 months of intraoral function
Brackett et al. Chlorhexidine preserves hybrid layers
but not nanofillers in vivo. Oper Dent (2009)
MMP inhibition with chlorhexidine
Potential ways to extend bond longevity
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•Courtesy Pacific University (Dr Marc Guisberger)
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•Courtesy Pacific University (Dr Marc Guisberger)
InstroN• Ultra Tester (Ultradent)
• Ultra Jig (Ultadent)
Ultradent’s shear bond strength testing method has been adopted as an ISO Standard. The UltraTester machine uses this highly accurate method to determine bond strengths.
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Ultradent Internal Testing
Shear Bond Test Results - 2012Average Shear Bond Strength to Dentin: 24.2 MPa
•Courtesy Pacific University (Dr Marc Guisberger)
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Maximum/Minimum Shear Bond Strength per Bonding Material
Shear Bond Test Results - 2012•Courtesy Pacific University (Dr Marc Guisberger)
Why different pH?
3.2 2.7 2.54.6
MDP Penta-P MDP BPDM
Adhesive Functional
Monomers
MDP
2.3 1.6
GPDM
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When bonding to enamel, an etch & rinse approach is definitely preferred, indicating that simple micro-mechanical interaction appearssufficient to achieve a durable bond to enamel. When bonding to dentin, a mild self-etch approach is superior, as it {MDP} involves (like with glass-ionomers) additional ionic bonding with residual HAp. This additional primary chemical bonding definitely contributes to bond durability. Altogether, when bonding to both enamel and dentin, selective etching of enamel followed by the application of the 2-step self-etch adhesive to both enamel and dentin currently appears the best choice to effectively and durably bond to tooth tissue
Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent Mater (2009),doi:10.1016/j.dental.2009.11.148
• Developed by Kuraray 1983
• Acidic Monomer Activates Silanes & Chemically Bonds to Metal Oxide Ceramics (Zirconia & Alumina).
• (Key Ingredient to make a Silane Universal)
• Hydrophilic & Hydrophobic
• Very Durable Dentin Bond
(Creates An Insoluble, calcium Salt with Dentin)
• Is The Most Copied Monomer In Dentistry
• The Most Researched Monomer In Dentistry
• 20 + Years Of Research On Metal Oxide Ceramics (Zirconia & Alumina)
• Strongest & Most Durable Bond to Metal Oxide (Zirconia & Alumina) Ceramics
MDP ADHESION MONOMER:
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NEW “UNIVERSAL” SYSTEMS
• Simple & easy to use
• Direct & indirect techniques
• Use as Total, Selective or Self Etch
• Low sensitivity
• Lots of MDP Based Products
G-PREMIO BOND (GC AMERICA)
• MDP based Universal Bonding Agent
• Total, Self or Select Etching
• Direct & Indirect Composites
• All Ceramics, including Zirconia
• Single bottle or Unidose
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Small Cases have increased Difficulty due to
• Color matching - take photos, and practice composite selection on tooth
• Translucency - take photos, extend composites off incisal edge
• Masking margins - preparation must have a bevel on one or both sides
• Texture• smooth surface is easy but takes longer to polish to eliminate imperfections
• anatomy and texture hides colors better and takes less time.
• Polish - use multiple viscosities and/or polishers
Class IV / Diastema Template Technique
Anterior Composite Bonding
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Vit-l-escence1994
high-translucency, opalescent/translucent
micro-hybrid system
average particle size of 0.7µm.
Vision is critical use photography
Black and White photography to see translucency effects
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Select all composite colors first before dehydration occurs
Place small increment of composite on tooth or extending from tooth and cure for 5-10 seconds.
Place
Evaluate color and add additional colorsEvaluate
Layer a translucent on top of dentin/body colors, or extend off of incisal edgeLayer
Create a Lingual Template whenever possible
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Extend bevel either half or full width of defect
Labial and lingual bevel or chamfer
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Labial and lingual bevel or chamfer
Labial and lingual bevel or chamfer
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Don’t over bevel on incisal edge, it creates more translucency to oral pharynx
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Use mylar when etching and bonding. Use wax floss on adjacent tooth if needed.
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Enamel shade on matrix to build a shelf
Compress composite into position
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Tease composite off adjacent tooth and adapt
Use mylar to create interproximal shape
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Hold against tooth for contour and pull to lingual
Light adaptation to push composite against adjacent tooth creates the contact. Use brush to thin facial finish line or metal instrument.
Try to create all anatomy and shape to minimize contouring steps with handpiece
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Begin to define line angles
Carborundum stone (Shofu) Dura-Green Stonesfor minimal reduction and texture
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Flip discs when contouring interproximal
• Coarse
• Medium
• Fine
• Super Fine
• Polishing Pastes
• Aluminum Oxide Buff
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Jiffy Polishing System
Absolute Polishers (Parkell)
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Polishing Systems
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Radiometers
RadiometerCheck daily in am300mW/cm2 (600mW /cm2)
How good is your light?Initial study by Dr.Nassar Barghi found
▪ 30% of units tested had output less than 200mW/cm2
▪ Second study <20%
▪ Intensity of light inversely proportional to age of unit
▪ 10% had cracked filters
▪ Most doctors never replaced the bulb
**Proper care of curing light will ensure that your restorations are thoroughly cured. **
• More efficient than Halogens
• Halogen produces light from 370 to 800 nm then filters out all
but blue light in 400-500 nm range
• Longer lasting / Cordless / Batteries
• Faster curing (5 seconds)
• Nanometer range closely matched CQ range (450-470)
• Smaller in size/lighter
• Less heat
Benefits of LED Lights
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Comparisons - Lights
Access to the curing site = Energy to the
resin
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$200 $205
$321
$73
$175 $175
$11
$0
$50
$100
$150
$200
$250
$300
$350
Demi Demi Plus Elipar S10 SmartLite Max Bluephase Style Bluephase G2, 16-20i VALO
Curing Light Replacement Battery Cost
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• Unidose and Syringes
• High density uniform dispersion 300nm spherical nanofiller technology
• Self shining effect allows the material to increase polish over time
• Excellent handling
• 17 Shades
• 2 Enamels
• 2 Bleach
G-aenial Sculpt Cosmetics
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Mockup shade and then remove composite interproximally. Restore one tooth to completion then the second tooth.No matrix is necessary as tooth shape is present.
Mockup shade and add length then create a matrix. Restore one tooth to completion then the second tooth.
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• Nanohybrid
• Superior handling
• High polishability & gloss retention
• Exceptional wear
• Unique syringe design
• Intuitive shade offering
One Shade of Mosaic
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Layered shade guide made of composite
13 Dentin Shades
Tapered Handle = Dentin Only
Tooth = Dentin + Enamel Neutral
6 Enamel Shades
Not Layered
Opaque White
Not Layered
2mm
.5mm
.5mm discs
Consistent chromatic progression between shades
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Shade is printed on syringe barrel
and handle tip of syringe
Convenient flip cap stays
connected to the syringe
Unique, hygienic syringe design is
easy to clean. The ergonomic handle
covers syringe threads for reduced
risk of contamination.
Shade category
indicated by color-
coded syringe handles
Enamel = White
Dentin = Beige
Use air abrasion whenever possible as it creates more surface area to adhere too.
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One Shade of Mosaic
One Shade of MosaicUse gauges to measure teeth to create best outcomes.
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One Shade of Mosaic
Measure both teeth and add to just the smaller tooth when ever possible. Pack a small #00 retraction cord to push tissue back.
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One Shade of Mosaic
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One shade this week
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Second Case This WeekThree Shades of Mosaic A3, EN, EY
Photos, Color & Trans, Mockup, Template
Key to Accuracy, Consistency & Speed
Three Shades of Mosaic A3, EN, EY
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Shape, Texture & Polish
Second Key to Accuracy, Consistency & Speed
Three Shades of Mosaic A3, EN, EY
Three Shades of Mosaic look at final texture and polish
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Large Cases are time consuming, but Easier
• Changing the color of many teeth at once is easier as you remove many of the small colors.
• Takes longer to do more teeth however.
• Use retraction cord at gingival to push tissues back so margins can be at or slightly under gum line.
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• Unidose and Syringes
• High density uniform dispersion 300nm spherical nanofiller technology
• Self shining effect allows the material to increase polish over time
• Excellent handling
• 17 Shades
• 2 Enamels
• 2 Bleach
G-aenial Sculpt Cosmetics
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Big Cases or Small Cases Do a Waxup
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Create a Template from the WaxupTemplate (Clinician’s Choice)
Try on Composite Shades to Evaluate Colors
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Isolate and use dry #00 retraction cords.Air abrade teeth or use a diamond bur.Treat each tooth individually with mylar. Do one tooth at a time.
Etch, bond, first layer of composite then add translucent enamel layer. Re-bond composite if composite is adjusted.
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Use fine diamonds or discs, carbides tend to ditch.
Use fine diamonds or carborundum stones for anatomy.
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Create anatomy and polish so as not to remove the anatomy for better light reflection.
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Jiffy Polishing System (Ultradent)
Use a System that goes from Coarse to Final Shine but be careful tonot remove anatomy
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Jiffy Polishing System (Ultradent)
Absolute Polishers (Parkell)
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Favorite Polishing Discs
Template Developed Bonding
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Disposable Single Use Operative Diamonds
TEXT “DIAMOND3” TO (770)212-2090
FREE!!
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NSK Electric HandpiecesWORLDS #1 SELLING HANDPIECESMALLEST HEAD & SLIMMEST NECKFREE TRIAL OFFER
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Immediately after use, thoroughly wipe template with alcohol pad, dry, bag, and autoclave according to Uveneer template IFU. Do not leave any composite residue on the template in order to maintain translucency and shine.
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CompositeProximalFinishing System
Contents:8 - Orange Serrated Diamond Strip8 - White Serrated Strip8 - Gray Final Polishing Strip
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Veneer Finishing System
Proximal Contour & CleanerContents:8 - Black Diamond Strip8 - White Serrated Strip8 - Blue Serrated Strip8 - Gray Final Polishing Strip
Booth (#3424) to receive a free sample.
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Nowadays good business
is extremely important.
These are my must haves
Implementing various technology and software tools
-Enhance dental care-Lower overhead-Improve performance-Increase Efficiency-Create A Higher Income
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Online Real Data
THE POWER OFACTIONABLE
METRICSDENTAL INTEL
.
New Patients
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NEW PATIENTS
HOW MUCH DO WE REALLY LOVE THEM?
RECAPTURED
PATIENTS
47 $65,114
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218
Before AfterHygiene Re-Appointment
$167,400 increase through Actionable Metrics
Hygiene Re-Appointment
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Delivering Best Dentistry
ACTIONABLE MONITORING DRIVES GROWTH
37%Increase in Production
In One Year!
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DENTAL INTEL
FIND OUT WHERE YOUR BUSINESS IS AT.
CHECK YOUR PRACTICE
FIRST 10 DENTISTS GET A FREE EVALUATION
FREE PRACTICE SNAPSHOT
223
223223
TEXT
“DATA” to
77453 (to waive $1,000 fee)
Free for first 10 people
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224For Your Free Practice Snapshot Go To: www.practicesnapshot.com
and use special code: Todd2017
Remember The Old Appointment Book?
How LONG Did It Take To Answer A Question About Balances, Forgotten
Appointments?
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• Weave
• VOIP Phone system ties into practice management system
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TEAMWORK• Auto confirms appointments and adds to the Practice Management
Software
• Auto Birthday Messages
• Auto propagation of messages
• Easy to implement with minimal time to use.
• Improve business opportunities dramatically
• Cuts down on current employee time by streamlining many tasks
• Saves money on traditional procedures
• Less postage
• Less paper goods
• Less employee time
• 2011 33% reported they did not trust online reviews.
• A recent study reported 88% of people trust online reviews
• 92% or internet users read product reviews
• 89% said it influences their purchases
• 74% of internet users said they would most likely not do business if there was a negative review
• Currently having one bad review is considered normal, but lots of bad reviews is not good.
ONLINE REVIEWS
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WEAVE REVIEWS VIA CELL PHONE MESSAGE
WEAVE REVIEWS VIA CELL PHONE MESSAGE
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WEAVE REVIEWS VIA CELL PHONE MESSAGE
Weave Mobile App
-Same functionality
-From anywhere you have a wifi or cell connection.
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TECHNOLOGY
ONLINE
Efficiency 24/7
Accountability
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Unit 1 Introduction Rapport
Unit 2 Foundation of Rapport
Unit 3Fundamental Techniques in Handling People
Unit 4 Six Ways to Make People Like You
Unit 5 Mirroring & Matching
Unit 6 Outcome of Calls
Unit 7 How to Build Rapport
Module 5 Rapport 2: Personality types
Unit 1 The Know-it-All
Unit 2 The Storyteller
Unit 3 The Easy Peasy
Unit 4 The Rusher
Unit 5 The Informationalist
Unit 6 The Nervous Nelly
Unit 7 The Indecisive
Unit 8 The Price Shopper
Module 6 Rapport 3: Advanced rapport
Unit 1 Empathy
Unit 2 How Long to Build Rapport
Unit 3 VIP Process
Unit 4 Positive Language
Unit 5 Elements of the Rapport Process
Unit 6 Phone Success Quiz #02
Module 7 Engage: Foundation
Unit 1 Introduction to the Engage
Unit 2 What is Engage
Unit 3 Proactive v. Reactive Scheduling
Unit 4 GREAT vs. EAGER Calls
Module 8 Engage: Elements of engaging the patient
• 14 Modules
• Quizes
• Exam
• 13 Modules
• Quizes
• Final Exam
Module 5 Working with Emergencies
Unit 1 Emergencies
Unit 2Scheduling Quiz #01
Module 6 Broken & Changed Appointments
Unit 1 Introduction
Unit 2Broken Appointment Policy
Unit 3Handling Broken Appointments
Unit 4Broken Appointments COSTS
Unit 5What patients must know
Unit 6Important Points
Module 7 Confirmations
Unit 1 Confirmations
Module 8 Early and Late Patients
Unit 1Early and Late Patients
Unit 2Scheduling Quiz #02
Module 9 Next Appointment Updates
Unit 1Next Appointment Updates
Module 10 Patient Reactivations
Developing
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1. Telephone Skills
2. Customer Care Protocols/Scheduling
3. Team’s Role/Training
4. Resource Library
5. 24/7
97% of offices don’t train.
(954) 323-2220
Inquire with “Heather” for a $200 Discount
Google Website Speed, Responsive Design and Build Issues/Code
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www.BLUX.com
Click VERIFY
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Type your website into the test area
Type your website into the test area
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Ngenys.com
Coming Soon!
FREE HANDOUTS, MARKETING INFORMATION, OFFERS, SOCIAL MEDIA LINKS & MORE
www.DENTOOLZ.com
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Thank you!
Todd C. Snyder, DDS, FAACD, FIADFE(949) 643-6733
www.aestheticdentaldesigns.comwww.drtoddsnyder.com