Dental Arabia ME August 2014

201408

I S S U E 0 3

International Academy of Ceramic Implantology

Volume 04

Winter Congress 2015 (Page. 19)

COVER STORY

CERAMIC IMPLANTS

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DOUBLE TAKE

“You need to check it out and add to your short list”... It may take a lot to “wow” DPR’s technol-ogy evangelist, but this curing light from Kerr definitely caught his attention.

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.

HOW TO

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

DOUBLE TAKE

“The delivery system is easy to clean, adaptive to patient and provider.” One clinician’s view of the A-dec 500 Chair System with the EA-52 LED electric motor handpiece.

TECHNIQUE

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

TECH BRIEF

Applying Planmeca PlanScan in your practiceA closer look at this ultra-fast intraoral scanner for open CAD/CAM.

TECH BRIEF

Applying SmartLiteFocus in your practiceA closer look at this new pen-style LED curing light.

Applying Sapphire Plus in your practice

TECH BRIEF

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

INSIDE LOOK

A l l k t

tLite

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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.

Our missiOn

Also in this issue

CliniCAl And teChniques ProduCt wAtCh ProduCts in PrACtiCe

IMPLANT

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

TECHNIQUE

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

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

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

TECH BRIEF

34 Applying Planmeca Planscan in your practiceA closer look at this ultra-fast intraoral scanner for open CAD/CAM.

35 Applying smartlite® Focus in your practiceA closer look at this new pen-style LED curing light.

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

37 solutions to everyday problemsHow one clinician is using Dentsply Caulk’s Aquasil Ultra Cordless impression system to solve problems.

TECHNoLogy EvANgELIsT

12 the amazing technology we are (or should be) using everydayAre 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

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

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

doUBLE TAkE

15 “the delivery system is easy to clean, adaptive to patient and provider.” One clinician’s view of the A-dec 500 Chair System with the EA-52 LED electric motor handpiece.

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.

MARkETINg

40 improving telephone skills can pay off big Examining existing internal processes can improve your marketing ROI without additional costs.

5 23 38

Product launches and updates from throughout the industry

Practical clinical advice, research and techniques Product impact on the practice’s bottom line

shOp the magazine - buy the prOduct

INsIdE Look

11 A close look at CBCt and its roi benefitsOnce you make your high-tech purchase, how do you know you’re getting the most “bang for your buck?” One dentist shares his thoughts.

PRoToCoL

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.

index dentAlArABiA

.ME Most Products. BEst sEarch. Find thousands of products on our website.

new Product lines Added to website

Clicks & Picks What dentists were searching and savoring in [email protected]

3 Most-Viewed Products

01 FR Kit neobiotech

02 Diagnocam Kavo dental

03 Icon dmG

3 Most-read articles online

01 Zabadne Sterling Dental Smile De-sign Weekend

02 USDA 2nd International Student’s Dental Conference 2014

03 Products Changing the Way Patients See Dentistry

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New products

theracal Lc®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.

Biscobisco.com

ecEMENt™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, three-unit bridges and inlays.

Biscobisco.com

Itena Pure BoostThe 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.

Itenaitena-clinical.com

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.


vOice

We want to knOw what yOu think about Dental Arabia ME. DPR Your comments are always welcome! Email [email protected].

40 products inside

this August issue

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.

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.

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.

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.

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.

truly yours,

dr. mohanna J. Abbas [email protected]

212-951-6600 | Fax: 773-847-6486 | [email protected] e n t a l p r o d u c t s r e p o r t .c o m

EdItorIaL offIcEsExecutive Vice President Georgiann DeCenzo

Vice President/General Manager John Schwartz

Group Editorial Director Kevin Henry

Editor in Chief Stan Goff

Managing Editor Renee Knight

Senior Editor Ryan Hamm

Content Specialist - Database Michael Quirk

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

Permissions/Licensing Maureen Cannon, 440-891-2742

MIddLE East EdItIoN EdItorIaL tEaMDr. Mohanna J. Abbas BDScieDent, MSc

Dr. Ninette Banday BDS, MSc

Dr. Sara B. Baldo BDS, MclinDent (Paedo)

Dr. Bisera Lakinska DDS, MBA

Managing Director – Dr. Mohanna Abbas

Marketing Manager – Dr. Bisera Lakinska, MBA

Art Director – Shahzad Mohammad

Coordinator – Jade Chavez

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,

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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.

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Get ConnectedVisit www.dentalarabia.me

Product wAtCh

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.

COVer StOry

cEraMIc IMPLaNtsthe 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.

5 aPdc Products

ItaLIaN couturE scruBz - PastELLIPastelli is an italian brand of couture scrubs and are said to be made entirely in italy and 100% in the plant of the company.

10 166

More products…

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22 ProduCts to Gofutudent cameraFutudent 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.

futudentfutudent.com


orangedental smart-padThe 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.

orangedentalorangedental.de

New zsystems Implant - z5 activeThe 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.

zsystemszsystems.com

Elexxion Pico diode LaserMade 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.

Elexxionelexxion.com

orangedental Pa-on PeriometarOrangedental’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.

orangedentalorangedental.de

tri hawk BursTri Hawk focuses exclusively on manufacturing dental burs and advocates the use of a simplified selection of single-use burs. Their regular carbide and crown-cutting 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 hawktrihawk.com

denmat Perioptix LoupsThe 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 ready-made 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.

denMatdenmat.com

3M EsPE filtek™ Bulk fill flowable restorativeThis 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.

3M EsPE3mespe.ae

ankylos 6.6 mm ImplantDentsply 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.

dentsply Implantsdentsplyimplants.com

Product wAtCh®

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APDC PRODUCTSProduct wAtCh®

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APDC PRODUCTS

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Product wAtCh Product wAtCh

LEd dental Light PoLarIsAs 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.

Gcommgcomm-online.com

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.

cerkamedcerkamed.pl

W&h alegra turbinesThe 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&hwh.com

Biolase Epic diode LaserThis 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.

Biolasebiolase.com

Italian couture scrubz - PastelliPastelli 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.

Pastellipastelli.com

NsK Endo-mate tc2 handpieceThis 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.

NsKnsk-dental.com

Lateral sinus approach Kit – NeobiotechThis 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.

Neobiotechneobitoech.co

carriere distalizer applianceThe 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.

carrierecarrieresystem.com

cErEc omnicamFeaturing 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 powder-free. 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 Inccereconline.com

Workflow scrubs by LandauThe 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.

Landaulandau.com

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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 diagnos-tic technologies that lead the list in 2014. The purchasing decision-making process

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 imag-ing software, and a basic understanding of CBCT image interpretation. This will

allow a practice to acquire images con-sistently and interpret the data quickly and accurately on command for optimal benefit.2. Develop a clearly defined practice pro-tocol 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 pro-vide. A practice protocol or flow sheet will standardize the use of CBCT for maxi-mum benefit.3. Every practice needs to have a con-cise understanding of the procedures for which that particular practice will utilize CBCT. Each practice will differ according to the procedures they per-form. 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 num-ber 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 consider-ation 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 cal-culating and planning ROI.

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 ]

A close look at CBCT and its ROI benefits

Planmeca ProMax 3dPromax 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.

Planmeca planmeca.com

“ 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.

dr. euGene AntenuCCiHuntington, n.y.

Product wAtCh inSide lOOK

sirona INtEGo treatment centerThe 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.

sironasirona.com

KaVo EstEtIca E70 t and E80 t in orchid PinkThe 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.

KaVokavo.de

denMat Lumi smile home WhiteningA 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 refrigeration-free 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.

denMatdenmat.com

carestream dental rVG 6200Offering 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.

carestream dentalcarestreamdental.com

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I was thinking the other day about change. Well, heck, I’m always thinking about change. After all, that’s what I do here, right? How-

ever, this time it really sort of hit home for me. I was thinking about my “new” office. In December, I will have been

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 f irst 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

aBout thE authorJohn 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.

we are (or should be) using

the amazing technology everyday

“Innovation is important and it pays to continue to keep up to date and evolve.”

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

computersFirst and foremost is the operatory com-puter. If you have not yet brought comput-ers 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

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 camerasYou 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.

Digital SLRs are not expensive and provide many benef its. 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!

intraoral camerasThese devices are truly one of the “unsung” heroes of the dental off ice. Ours is sleeved and ready to go for every procedure and every hygiene visit. Tak-ing 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 opera-tory. With hard drive space so plentiful, there’s no reason not to take lots of pic-tures 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.

digital radiographyThe 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 infe-rior 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),

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 con-text, why would someone not want to go digital?

Patient educationAll of the things I’ve mentioned in this article are—in one way or another—visual tools. Studies show that some-where 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 edu-cation 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 treat-ment is necessary.

Using a system like Guru, CAESY, ConsultPro or others lets communica-tion 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.

wrapping it upInnovation 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!

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 . J o h n F l u c k e

Product wAtCh teCHnOlOGy eVAnGeliSt


Product wAtCh dOuble tAKe Product wAtCh dOuble tAKe

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 cur-ing devices a step further. It has “Ultra” in its name because it uses an ultraca-pacitor. 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 amaz-ing. 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 impor-tant 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 bat-tery. Second, having to use less power means that less heat is also being gener-ated. 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 cur-ing 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.

demi ultra ultracapacitor curing LightThe 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.

Kerr dentalkerrdental.com

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

dr. JOHn FluCKelee’S Summit, mO.

“The delivery system is easy to clean, adaptive to patient and provider.” One clinician’s view of the A-dec 500 Chair System with the EA-52 LED electric motor handpiece.

Compiled by ANNA SACKS

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

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 o�ce in March of 2008.

your needs?

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

How has it worked out for you so far?

-ably, quickly and with better accuracy.

What was the process of incorporating this product like?Incorporating the product was easy because I built the o�ce new. A-dec allowed me to con�gure whatever I

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

trying to keep the price of doing dentistry low for everyone.

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

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

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

-

more comfortable, we care about them.

Why would you recommend this product to a colleague?I would de�nitely recommend the product to others because you can’t beat the comfort and e�ciency that it provides.

DR. MONICA LEEPRACTICING SINCE 1999

A-dec 500Built 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-deca-dec.com

[ ]


CerAmiC imPlAntScoVEr storY

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.

cEraMIc

IMPLaNts


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.

dental arabia ME: Why is there a need for a ceramic Implantology association?

Dr. Nou m bi ss i : 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

same spirit not only to organize metal free implantology but also to provide the profession as a whole with quality and h igh level cont inuing implant education and the public with a greater understanding of the benef its of metal free ceramic dental implants.

dental arabia ME: When presented with the idea of ceramic implants most d e n t i s t s d i s m i s s t h e m as unre l iab le and even experimental but you preside over an organization fully d e d i c a t e d t o c e r a m i c implantology. how is that?

Dr. Noumbissi: This goes back to the need to have organized groups even within specialties because in today’s world research 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, lea r n i ng a nd shar ing innovat ive techniques and materials, members have a forum where

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

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

Dr. Sammy Noumbissi President of the IAOCI

ExClUSIvE INTERvIEW

Zirconia Implant

Zirconia Crown on Zirconia Implant



and methods of production comes with problems and cha l lenges. A lthough 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 monocrystal l ine 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 see you lecture in two dental 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.

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.

dental arabia ME: can you tell us what can we expect from the IaocI for next year?

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

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 recommendat ions 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.

Dr. Sammy speaking at the last year’s IAOCI Congress

IAOCI Congress 2014 speakers


CerAmiC imPlAntScoVEr storY CerAmiC imPlAntScoVEr storY

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 “Zirkol ith®” process, which embraces our vast experience in the f ield of development, materia l 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

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

dental arabia ME: can you please elaborate further about the benefits of ceramic implants?

Dr. Luettmann: Recently there have been an increased number of studies which report immunologica l reactions attributable to titanium, whereas ceramics are hypoallergenic and immunologically neutral. In addition, it was been proven that the plaque aff inity 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 peri-implant 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 aesthet ics. Now the t issue is the issue. Ceramic implants offer perfect white esthetics without visible grey rings or shadows, even in case of thin or receding gingiva.

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 specia l manufactur ing 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 work ing with zirkolith® all ceramic implants require any special skil ls from the implantologist?

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

zsystEMs A lOOK At

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

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 two-piece 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.

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.

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

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.

Zsystems at ADPC

Clinical case - Three Zirkolith implants before cementation

Clinical case - After cementation

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Zirkolith_AnzE_1/3_DAME_240714.indd 1 24.07.14 16:01


COVer StOry

teCHnique

CliniCAl

teAm APPrOACH

SOlVe my PrOblem

teCH brieF clinical & techniques

62 teCHnique

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.

teCHnique

sIMPLIfy thE dIrEct rEstoratIVE ProcEss using a universal adhesive with multiple composite resins from ivoclar Vivadent for great clinical results.

80 teCH brieF

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.

26

[ in tHiS SeCtiOn ]

30

36

in this issue in Clinical & techniques

we have some old and some new

techniques to apply in your practice.

Make sure you check a diode laser

application for gingival depigmentation

in the How to article on page 26.

dENtIstry at its VERsitiLitY

COmPANy PROFIlE enterPrise 360°

oraNGEdENtaL A lOOK At

Featured 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, diag-nosis and treatment in the field of den-tistry. We specif ically focus on X-ray diagnostics, disinfection, periodon-tics, endodontic, restorative dentistry and development of improved vision appliances, such as dental loupes, den-taloscope and intraoral camera. One interest ing fact about our company is that it was founded and it is owned by the grandson of the founder of

KaVo Dental – Mr. Stefan Kaltenbach. Orangedental has around 50 employ-ees and of fers world - wide distribu-tion. 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: We support and drive the con-tinuous development in dentistry offer-ing 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 offer-ing ways for dental office to differentiate their services.The high quality of the products we offer is equally important as the qual-ity of the customer services we provide. In this respect, we align the quality and the service to provide a smooth and suc-cessful 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

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 f irst periometer for a fully automated assessment of the periodon-tal status. The device simplif ies and standardizes the recording of the peri-odontal 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, steril-ized 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 profes-sionals (dentists or dental assistants). Measurement values can be read of f and manual ly documented or wire-lessly 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. 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 den-tistry and is a part of a complete chain of processes, ranging from contact-free, opto-electronic recording of mandibu-lar joints, to computer-integrated plan-ning tools and systems for navigated implementation of planning and high-precision milling techniques for fabrica-tion of prostheses. The ultimate goal is to integrate these new technologies into a barrier-free workflow management and to of fer novel logistics and advanced services, enabling the dentists to pro-vide quality-certif ied, ef fective and eff icient medical performance. Using Freecorder®BlueFox, interfaces with conventional dentistry. It allows for a gradual introduction of novel technolo-gies and improved treatment methods into in the dental practice. The revo-lutionarily straightforward, contact-free and af fordable mandibular joint recording with Freecorder®BlueFox opens entirely new approaches to the diagnosis and treatment of conditions of the mandibular joint.

smart- Padfreecorder®BluefoxPa-on Periometar

orangedental Gmbh & co. KGAspachstr. 11, D-88400 Biberac, Germany Phone: + 49 (0) 7351 / 474 99-0Fax: + 49 (0) 7351 / 474 99–44Email: [email protected]: www.orangedental.de

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

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

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


CliniCAl&teChniques imPlAntthe taKE-aWays Ȝ All areas of the mouth, or areas to graft benefit through CBCT. Ȝ CBCT can deliver simpler implant and bone graft cases.

1

2

3

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.

at a glance

in the March issue of Dental Products Report I started a three-part series about treat-

ment planning for dental implants with Cone Beam CT imaging (CBCT). In that article, the basics of CBCT imag-ing were outlined and the importance to treatment planning for dental implants was made clear. Also it was shown how by using various CBCT imaging com-panies such as 360imaging in Atlanta or nSequence in Reno, Nev., little invest-ment is needed to use this technology.

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

a need for implantsAccording 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 Cali-fornia 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

Clinically speaking, 3d a must havePart ii of a three-part series on how CBCt is transforming treatment planning for implants.

[ by dr. michael tischler]

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.

wHat’s next?

the sEt-uP

“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

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).

the tEaM

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

tEaM MEMBErs

Dr. Brien Harvey (Lead)

Dr. Michael Tischler

Dr. Lee Gause

Dr. Joyce Warwick

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.

52% of GPs offer implants services in their practice.

CliniCAl&teChniques imPlAnt

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best long-term solution for tooth replacement both from a prosthetic survival rate and func-tional 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 There is not one area of the mouth that should be excluded for a CBCT when treat-ment planning for dental implants or bone grafts. All four quadrants in the mouth require a CBCT to prevent iatrogenic dam-age 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 mid-buccal portion (Fig. 1).

A 2D view from a panograph or periapi-cal 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 casesIn the anterior mandible, a CBCT is indis-pensable. With a 3D view the positions of the mental foramen and mandibular nerve can be identified. It also can show the implant posi-tion 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 accu-rately. 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.

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.

QuIcK BItEs for team development and practice success

the LIst

tOP 4WAyS tO extend tHe liFe OF dentAl mAteriAlS

properly cure your restorationProper curing begins by placing your curing light directly above your mate-rial, 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 numer-ous 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.

choose a universal adhesive to ensure long-term 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.

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 situa-tions. 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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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 non-Caucasians, 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 Den-tist. It was based on laser treatment, with the use of elexxion claros 30W, digitally pulsed laser we have at our clinic.

01stEP 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 cer-tain level of numbing, against the action of the laser.

The laser used – elexxion claros, is a digi-tally 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 tis-sue to cool down.

02stEP 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 tis-sue and slowly bring it closer.

03stEP 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 main-tained 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 post-operative result is shown in (Fig. 2), which shows the blanching of the t issue 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 eat-ing a very hot soup, with a resultant blister in the mouth. This technique is not pain-ful and as far as this patient is concerned, there was no discomfort at all.

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.

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

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

[ by dr. bassam m. Ahmad bdS, FibmS ]

CliniCAl&teChniques teCHnique

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.

hOw tO

dr. bASSAm m. AHmAd, bdS, FibmS

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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 excel-lent and stable result from a single treatment lasting around 1 minute.

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

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 anaes-thetic 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.

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.

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 tech-niques 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.

4. Removal of gingival melanin pigmentation with the semi-conductor 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.

5. Clinical application of a digital pulsed diode laser in depig-mentation 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

At A GlAnCe Fig 1 Pre-operativeFig 2 Immediate post-operativeFig 3 Immediate post-operative close-upFig 4 Immediate post-operative detailed viewFig 5 Follow-up 3 weeksFig 6 Follow-up 14 months

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 whit-ening for both vital and non-vital teeth (using elexxion Odo-bleach); 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.

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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 promi-nent 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 indica-tive of a history of decalcification.

Noting the decalcif ication, 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 selec-tion of colors, and its ability to allow underlying tooth structure to enhance the composite’s appearance.

Some of the qualities that I appreci-ate 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 f iller loading and strength. • A big bonus is its low flexural modu-lus. This means better fracture resis-tance 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 emu-late young enamel for those who are 20 or younger.

01stEP Surface discolorations and previous composites were conserva-tively removed with a f lame-shaped diamond, maintaining the outer enamel and creating room for the forthcoming layer of Aura.

02stEP Treatment sequence of bond-ing 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 ef f iciently and effectively.

03stEP 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.

04stEP A universal bonding resin was placed carefully placed using a micro-brush and thinned with a warm air dryer.

05stEP 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 por-tion is adapted to the tooth using the anatomy of the incisal edge and adjacent anatomy to guide initial contouring.

06stEP 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.

Overall, she was very happy with the results and could finally flash the con-fident smile of completed orthodontic treatment.


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dr. HuGH FlAx, ddS, AAACd, FiCOi

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

[ dr. Hugh Flax ] information provided by Sdi (north America) inc.

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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.

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.

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

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

10. and 11. Conservative preparation of enamel surfaces.

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

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.

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

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

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

21. Greater esthetic brightness and occlusal harmony are evident intraorally.

22. Gingival health and soft incisal anatomy are welcomed outcomes in this case.

At A GlAnCe

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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

aura

SDI sdi.com.au



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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 natu-ral dentition, providing a significant esthetic advantage that contributes to their popularity and placement fre-quency.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 com-bination of these materials that achieves the desired outcome, particularly when multiple restorations are placed.

complementary composite systemsA direct composite placement approach using multiple components is ideal when patients present with several clinical issues that require different preparations and restorations. A flow-able 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 restora-tions. It is a flowable yet highly stable composite available in multiple shades to achieve ideal esthetics. The mate-rial’s innovative Viscosity Controller ensures that this f lowable composite is evenly distributed throughout the preparation to prevent voids.

A nano-hybrid composite resin (Ivo-clar Vivadent’s IPS Empress Direct) can be used for anterior and posterior restorations for which a f lowable com-posite is not sufficient. Light-curing and extremely esthetic, this composite is available in 32 shades and five levels of translucency, according to the manufac-turer. 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 radi-opacity, enabling clinicians to easily dif-ferentiate between natural dentition and restorations on radiographs, allowing for easier detection of secondary caries.

a universal adhesiveAlthough successful treatment may require more than one direct compos-ite resin, clinicians can save time by employing a universal adhesive system (Ivoclar Vivadent’s Adhese Univer-sal) for all restorations. Adhese Univer-sal is a single-component, light-curing adhesive indicated for both direct and indirect restorations. Because the sys-tem is compatible with all etching tech-niques (e.g., self-etch, etch and rinse, selective-enamel-etch), clinicians are not limited to specif ic 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 manufac-turer, 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 suc-cessfully restore a patient’s dentition.

case presentationThe patient presented with a fail-ing composite restoration on tooth No. 13.

01stEP Upon examination, primary caries were also discovered on tooth No. 12 (Fig. 1). After discussing treatment options with the patient, it was deter-mined that direct composite restorations would be appropriate and provide a con-servative treatment. A flowable composite (Tetric EvoFlow) and an esthetic compos-ite 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.

dr. rOnny WAtZKe

siMPliFY the direCt restorAtive ProCessusing a universal adhesive with multiple composite resins from ivoclar vivadent for great clinical results.

[ by dr. ronny Watzke] information provided by ivoclar Vivadent.

hOw tO


1. the patient presented with a failing composite restoration on tooth no. 13 and primary caries on tooth no. 12.

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

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

4. the adhesive was light cured with a led curing light (bluephase Style) for 10 seconds.

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.

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.

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.

16. A flowable composite (tetric evoFlow A2) was applied to the preparation.

17. A nano-hybrid composite

material in shade A3 dentin (iPS empress direct) was placed .

18. the composite material was sculpted and contoured.

19. Composite material in shade A2 enamel (iPS empress direct) was applied to the preparation.

20. the marginal ridges of tooth no. 13 were mesial and distal sculpted.

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 high-gloss polished with an additional polishing system (Astrobrush).

32. the occlusion was verified.

33. Post-operative view of the final restorations (one week after placement).

At A GlAnCe

Single adhesive for all materials and techniques

· High bond strength and virtually no post-operative sensitivity

· Available in the revolutionary VivaPen

adhese universal

Ivoclar Vivadent ivoclarvivadent.com

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02stEP 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).

03stEP A single-component adhesive (Adhese Univer-sal) 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).

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

05stEP The restoration was then polished with polish-ing discs (3M ESPE’s Sof-Lex) [Fig. 7].

06stEP A sectional matrix system was placed to tooth No. 13 (Fig. 8). The enamel preparation was etched for 15 sec-onds (Fig. 9), and the entire cavity preparation was then etched for an additional 15 seconds (Fig. 10).

07stEP 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).

08stEP 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).

09stEP 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).

10stEP 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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11stEP A characterization mate-r ia l (Ivoclar 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).

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

13stEP 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 o c c l u s i o n w a s v e r i f i e d , (Figs. 30-32). The patient was very p l e a s e d w i t h t h e o u t c o m e (Fig. 33).

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

references1. Perdigao J, Lopes M. Dentin bond-ing state of the art 1999. Compend Contin Educ Dent 1999;20(12):1151-1162.2. Latta MA. Recent advances in dental adhesives-part 1. Inside Dentistry. Retrieved online at https://www.den-talaegis.com/special-issues/2010/06/recent-advances-in-dental-adhesives-part-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.dentalae-gis.com/id/2007/08/direct-composite-resins.

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aBout thE author

Dr. Ronny Watzke is head of the dental clinic of Ivoclar Vivadent̀ 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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A closer look at this ultra-fast intraoral scanner for open CAd/CAM.

[ Compiled by Stan Goff ]

Applying Planmeca PlanScan in your practice

The Planmeca PlanScan, driven by E4D Technologies, is described as an innova-tive, technologically advanced, ultra-fast intraoral CAD/CAM system for restor-ative 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 intui-tive computer-guided image capture to plug-and-play technology that gives you the freedomto scan at multiple Planmeca PlanS-can workstations. Additionally, it’s powder-free.

OPtimAl ACCurACy: It’s the only intra-oral 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™,

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 Plan-meca Romexis software can now share images (2D and 3D) and documents with minimal effort via a Planmeca Romexis Cloud. Information is securely trans-ferred into the cloud and the recipient is automatically notif ied of new cases requiring his or her attention.

Planmeca cad/ caM division E4d technologiese4d.com

Are yOu reAdy tO APPly tHiS teCH-nOlOGy in yOur PrACtiCe?

information provided by Planmeca CAd/CAm division e4d technologies.

CliniCAl&teChniques teCH brieF CliniCAl&teChniques teCH brieF

Applying Smartlite® Focus in your practiceA closer look at this new pen-style led curing light.

[ Compiled by Stan Goff ]

information provided by dentSPly Caulk.

dENtsPLydentsplymea.com

Are yOu reAdy tO APPly tHiS teCH-nOlOGy in yOur PrACtiCe?

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.

uniFOrm PerFOrmAnCe: Many lights 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 aver-age Class II restoration. Optics ensure a homogenous beam profile for uniform performance in the curing area.

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 Tech-nology checks the battery conditions and initiates the proper charging mode:

“automatic quick charging mode” for 5 minutes of cure time with just a 10 min-ute charge, “standard charging mode” to achieve a full charge in less than 3 hours, and “standby mode” which pre-vents overcharging when not in use. The SmartLite Focus Replaceable Battery Pack offers stable energy output even after prolonged storage.

Added PluS: With single-button sim-plicity for a 20-second curing cycle, and ergonomic design, the curing light pro-motes consistent use across operators.


Applying Sapphire Plus in your practice[ Compiled by dental Arabia middle east ]

information provided by denmat.

denmatdenmat.com distributed by Zabadne sterling dentalexclusive distributor for denmat products in GCC, Me, Afr ica, Cis and turkeylumineers.me

Are yOu reAdy tO AP-Ply tHiS teCHnOlOGy in yOur PrACtiCe?

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 whiten-ing 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.

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.

CliniCAl&teChniques teCH brieF

tHe ProbleM: crowns not seating properly

“I’ve had a problem with crowns being high. [I’ve had] to do adjust-ments 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 every-thing 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.”

solution: change the system

“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 differ-ences 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.”

tHe ProbleM: wasted material and patient discomfort

solution: no waste at all and happier patients

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 con-sistency 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 sys-tems, 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.”

conclusionDr. 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.

how one clinician is using dentsply Caulk’s Aquasil ultra Cordless impression system to solve problems. [ by Stan Goff ]

solutions to everYdAY ProBleMs

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 head-ing into the Chicago dental Society midwinter meeting to stock up on the relatively new product.

CliniCAl&teChniques SOlVe my PrOblem


PrOtOCOl ProduCts in PractIcE

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 gluten-free 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 hydroxyap-atite molecules are well received, as are products containing NovaMin.

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

cal barrier and has none of the issues tradi-tional 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 tempo-rary filling material in frank, open, and incipient lesions.

P rox i m a l le s ion s on adjac ent teeth may be repaired using Pho-col f luor ide disks f rom Col ldent

(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 loca-tion, 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.

non-fluoride options Fluoride may be a difficult sell to families with children on the autism spectrum, and that means non-fluoride options bet-ter 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

SHirley GutKOWSKi, rdH, bSdH

What is Autism?Autism spectrum disorder (ASd) and autism are general terms for a group of complex disorders of brain develop-ment, according to autismspeaks.org. these disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal com-munication and repetitive behaviors.

“ start to gather intel on aut ism spectrum disorder and how autism is successfully treated today. ...Look for products that fit the sensibilities of these families and you my find a wonder-ful way to treat all families.”

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.

yremin Pro from VOCO is a protective cream that helps strengthen, remineralize and desen-sitize teeth.

ProduCts in PractIcE

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 interest-ing studies showing dental benef its, although xylitol is still the go-to sugar for dental health.

the benefits of fluorescence technology Radiation is always going to raise a red f lag 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 radio-graphs. Transillumination is an option,

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.

did you know...

Autism now affects 1 in 88 children.

Source: Autismspeaks.org

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

become more educated Start to gather intel on Autism Spectrum Disorder and how autism is success-fully 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

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 [email protected].

PrOtOCOl

PORTION CONTROLMaintaining expenses is all about divvying things up correctly.Compiled by t h e p r i D e i n s t i t u t e

It’s difficult for a dentist and team to visualize the true impact expenses have on the practice’s potential suc-cess. 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 Collec-tions 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 integra-tion 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.

5–7% Facility expenses

10–12% General and administrative costs

5–7% Dental supplies

3–5% Promotions

10–14% Lab costs

22–38% Employee expenses

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

<10% Discretionary expenses


ProduCts in PractIcE mArKetinG

increasing new patient flow ... it’s a common goal among dental practices across the country.

Marketing is certainly an important com-ponent 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 exter-nal 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 impor-tant 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 essen-tially 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

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 callThe front desk team needs to properly establish a good rapport during the conversation, so one key thing to remem-ber 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.

improving telephone skills can pay off bigexamining 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

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 morn-ings or afternoons work better for you?” not only gives the front desk team further insight into the prospective patient’s life-style, but says to the patient that the prac-tice 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 sub-jectively 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 con-versely, 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 ben-efits. The fees for this service in our practice vary anywhere from X to Y based on the complexity of your case -- I know the doc-tor 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.?”

two options for trackingMeasuring the verbal skills – and con-version 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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ProduCts in PractIcE mArKetinG

option 1 - diYThe 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. Friend-ly’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 refer-ral 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 num-ber 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 addi-tional 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 com-fortably 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

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 informa-tion 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 VendorThe 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, off ice 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 den-tal 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 posi-tive 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 mar-keting 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 maxi-mize the time, money and effort directed to all marketing efforts.

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Dental Arabia ME August 2014