Making - Aurum Group · Let’s talk about Tooth Preparation Design! ... Website registration with full details coming soon ... Clinical/Restorative Outcomes and Superior Profitability

Making Minimum Prep Veneers A Breeze!Cast PartialsTitanium Frameworks – Lighter, Biocompatible and Corrosion Resistant

Hot TopicsNEWS ALERT! Toothaches and Obstructive Sleep Apnea (OSA) Causes TMD Pain!

Technique Tip Effective Communication Between Clinician and Technician:Let’s talk about Tooth Preparation Design!

Visit us at www.aurumgroup.com

continuumThe Aurum Group - Specializing in Comprehensive Aesthetic & Implant Dentistry

Volume 18, Issue 3

Complete Root-to-Tooth™ SolutionsThe Aurum Group – All Under One Roof

Save the Date…

LAUNCHING the EVENT OF THE YEAR Dental Technology and Business Growth Summit October 1–3, 2015 In Banff, Alberta

Mr. Chris Hadfield “The Sky is not the Limit”

Ms. Arlene Dickinson“Lessons from the Den:

Succeeding at Business & Being an Entrepreneur”

Website registration with full details coming soon…www.aurumgroupsummit.com

For more information or to reserve your spot today: Phone: 1-800-363-3989 Email: [email protected]

You don’t want to miss this, there is nothing like it!

When: October 1 – 3, 2015

Where: The Banff Centre 107 Tunnel Mountain Dr, Banff, AB T1L 1H5

Room rates: The Banff Centre Starting at $170 per night, plus applicable fees & taxes

Call 1-800-884-7574 to reserve your room and quote “TAG1510” for the special rate.

Registration Fees*: Early Bird: Register prior to After April 30, 2015 April 30, 2015Aurum Group Platinum** Clients: $1395.00 $1595.00Aurum Group Clients: $1595.00 $1795.00Non-Client Dentist/Technicians/Lab Owners: $1795.00 $1995.00Team members (first three)/Spouse: $995.00 $1195.00 – (for additional over 3 team members) $795.00 $995.00

*Registration fees are subject to GST and are in Canadian Dollars.**Certain criteria applies.

A percentage of the registration fees will be donated to the Children’s Toothfairy Foundation.

• Mr. Vince Barabba – Author of “Decision Loom: The Demise of Kodak”

• Dr. Joe Blaes – Editor of Dental Economics

• Dr. Jonathan Ferencz – Professor of Prosthodontics and Occlusion in the Department of Advanced Education in Prosthodontics at the New York University College of Dentistry and Scientific Chair of 1st International Symposium of Digital Dentistry – “How open digital technologies and work flows not only equal analog dentistry but surpass it!”

• Mr. Albert Giralt – President, Grup Villardel Purti – “Commoditization, Vision, Innovation, and Deploying Technology for Market Disruption and Success: the Avinent and Core3dcentres Story”

PLUS

• Dr. Fred Li – Dr Fred Li – Entrepreneur, Implantologist, and Educator – “Live Surgery: Leveraging the Complete Digital Workflow for Best-in-Class Clinical/Restorative Outcomes and Superior Profitability”

• Dr. Brent Boyse – Oral and Maxillofacial Surgeon – “Treating full arch immediate load patients”

• Mr. Avi Kopelman – Founder of Cadent, Inventor of iTero, Chief Scientist of Align Technologies – “Reading the Market, Innovating, and Creating Technology to Change the Market”

• Mr. Ron Huntington – Owner, Executive Mentors & Trainers (Founder & Emeritus Head Coach, Gazelles and Gazelles International)

In the News: Contents

Aurum Group Presents $9,000 to Ottawa Civic Hospital Dental Clinic!

Advanced EstheticsMaking Minimum Prep Veneers A Breeze!Dr. Danièle Larose

Cast PartialsTitanium Frameworks – Lighter, Biocompatible and Corrosion Resistant Gary Wakelam

Case SpotlightErnie Wotton

Case SpotlightDr. Pamela Marzban

Hot TopicsNEWS ALERT! Toothaches and Obstructive Sleep Apnea (OSA) Causes TMD Pain! Louis Malcmacher

Technique TipEffective Communication Between Clinician and TechnicianLet’s talk about Tooth Preparation Design!Ulf Broda

Consultants CornerQuestions are the Answers (Part 3) Sherry Blair

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The management and staff at Aurum Ceramic Dental Laboratories and the Aurum Group of companies were pleased to recently present the proceeds from their Annual Aurum Classic Golf Tournament to the Ottawa Civic Hospital Dental Clinic in support of the Clinic’s programs. The Ottawa Civic Hospital Dental Clinic is the only full service adult dental care clinic in Eastern Ontario that provides specialized care for in-hospital and outpatients who are medically compromised.

The Aurum Group of Companies has always been committed to supporting dentistry with not only the most technologically advanced restorative materials and techniques available but also in terms of research, education and program assistance. We are proud to be a Platinum Lab Partner at LVI Global (The Las Vegas Institute of Advanced Dental Studies). The Aurum Group works closely with Common Sense Dentistry (Dr. Louis Malcmacher) and PTC; is a Corporate Gold Member of AACD; and are supporters of Oral Health America and many other foundations and initiatives.

17p David Costanzo, General Manager, Aurum Classic Dental Lab (left) presents cheque to Dr. Jonathan Mayer DDS, Clinical Director, Ottawa Hospital Dental Clinic.

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Aurum Ceramic® Dental Laboratories LLP E-mail: [email protected]

Spokane 1320 N. Howard, Spokane, WA 99201-2412 (509) 326-5885 Toll Free 1-800-423-6509

Visit our Website at: www.aurumgroup.com

Except where specifically stated otherwise, views expressed in this newsletter are the opinions of the individual contributors and do not reflect the views of the Aurum Group. The information contained herein is not intended to be comprehensive and readers are advised to rely exclusively upon their own skill and judgement and to inquire further before acting on the information. The Aurum Group assumes no responsibility for any errors or omissions found herein nor for any loss or damage caused by any errors or omissions, whether such errors or omissions are the result of negligence or any other cause. Offers contained in this newsletter are not valid where prohibited by provincial regulation.

© Aurum Ceramic Dental Laboratories LLP (2013) All Rights Reserved.

Continuum™ is published by Aurum Ceramic Dental Laboratories LLP on behalf of the Aurum Group™ of Companies

Check out “Upcoming Courses”off the NEWS & EVENTS Menu at www.aurumgroup.comfor details on all of the upcoming programs and events in your areas.

Certification Number: AJAEU/09/13949

Case Study

This female patient has a health condition that creates extreme acidity, recurring caries, sensitivity and staining on all of her teeth (Figure 1). Over the years, her teeth have been restored with composites many times (Figures 2-7). While continuing to replace her failing composites and new caries with new composite material was still an option to resolve her situation in the short term, I suggested Aurum’s Cristal Veneers® from Aurum Ceramic® labs as a more permanent solution. As these veneers are very thin, they would protect her restored remaining good enamel under the failing composite fillings. Only a larger MID filling on tooth #21 would have to be removed. The other teeth involved would only require very light preparation with this treatment plan, which would ensure comfort and longevity. After discussing the pros and cons of the various treatment options with her, the patient chose to proceed with 10 Cristal veneers.

Along with restoring her oral health, we decided jointly to lengthen and widen her smile at the same time. The patient selected an actual picture of a smile mimicking the type of smile she loved (Figure 8). Based on our supplied photos, impressions/models, and my thorough discussion with the patient regarding shade and shape, the Aurum Ceramic AE (Advanced Esthetic) Team™ prepared a Diagnostic Wax-up (Figure 9) as per their ACCES™ system, showing the patient how the aesthetics of her smile, using LVI Golden Proportions and following my recommendations concerning smile design, could be enhanced. Perhaps even more important, she was able to try-out her new smile and request any changes before we prescribed the actual new veneers. The Aurum Ceramic Advanced Esthetic (AE) Team also provided Prep Indices, Bite Stent and Siltec Provisional Stent.

As you see in Figure 10, the prep model showed that very little, if any, tooth reduction was necessary to achieve the smile we are looking for. Also, note that because we plan on lengthening the teeth, no reduction is planned for that area. (Figure 11-13) The probe in (Figure 11) indicates we have plenty of room for a 1.5 mm incisal porcelain 05

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Dr. Danièle Larose Dr. Danièle Larose graduated from the University of Montreal’s School of Dental Medicine in 1997. She is in private practice in Ville St. Laurent (a suburb of Montreal) where she focuses on Cosmetic and Reconstructive Dentistry.

Dr. Larose attended the Dawson Institute and the Las Vegas Institute for Advanced Dental Studies. For the past eight years, she has been receiving great reviews teaching full-day hands-on classes devoted to anterior aesthetic techniques in Eastern Canada and the U.S. Dr. Larose was a featured speaker at the 2010 Women’s Dental Conference, a clinical instructor at the 2011 AACD meeting and a speaker at the 2012 AACD meeting in Washington, DC. In 2013, she was invited be part of the teaching faculty at the Center for Esthetic Excellence in Chicago, Illinois. Her work and educational articles have been featured in Continuum and Oral Health magazines. Dr. Larose is a member of the LVI Study Club, AACD, CAED and ODQ.

Over years of daily practice, I have found that nothing compares to the feelings of satisfaction and accomplishment I can achieve when a patient asks “How did you do that?” on successful completion of an “instant orthodontics” and “smile lift” restorative procedure. Depending on the individual casesituation, this might be with direct composites, minimum or full prep veneers, or a combinationof the two. I’ve also found that an excellent laboratory partner in these efforts is essential to that success. I have worked with Aurum Ceramic exclusively over the past ten years and on many cases. Not only do they provide outstanding esthetics and accuracy, they also supply invaluable advice and a series of tools that make restoring applicable smiles with their exclusive Aurum’s Cristal Veneers® a breeze!

This is perhaps best illustrated by looking at an actual case example first and then sharing a few critical tips I have found make these cases a success.

edge. Very light shaping and contouring was performed to ensure adequate fit and longevity of the thin Aurum’s Cristal Veneers® veneers. The corners must be rounded to avoid stress in these areas (Figure 14). We then took the Stump shade (Figure 15) Provisionals were created using the Siltec Provisional Stent (Figure 16).

We restored her upper anteriors with the ten Aurum’s Cristal Veneers®, all beautifully crafted by Aurum Ceramic (Figures 17-23). The veneers were cemented with MPA bonding agent and Rely-X Veneer cement. The patient is extremely pleased with her investment as her new veneers are not only comfortable but the color and new shape bring out her beautiful facial features (Figure 24).

Making Minimum Prep Veneers A Breeze!Dr. Danièle Larose, DMD

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Keys To Success With Minimum Prep Veneers

1. Excellent Communication gets you great results every step of the way.

The most important part of an esthetic case is the discussion with the patient beforehand as to what their esthetic goals are. Carefully note the patient’s desires and expectations. Determine if a no prep or minimum prep veneer achieves these goals and still provides a functional restoration. Outline the trade-offs for the patient in terms of preparation,

comfort, cost, time and outcomes of the various possible treatment possibilities. If minimum prep veneers are indicated, discuss with the patient how much polychromicity and incisal translucence is desired.

Ensure there is adequate centric, protrusive and lateral excursive clearance when designing the case.

Make sure you supply the “Basics” to the Laboratory

• Thoroughly detailed prescription denoting which teeth are to be veneered as well as selected shade.• Clear and accurate upper and lower full arch impressions or study models.• Bite registration.• For your first few cases, I recommend sending study models for suggested prep designs for minimal / no prep veneers. Every case is unique.

To get a great wax-up, and a great final result, make sure you let the lab know:

• the dimensions of two centrals.• the overall shape of desired teeth (with the case outlined earlier in this article, we sent an actual picture of a smile the patient selected mimicking the type of smile she loved) (Figure 8).• Mention how “pointy” you want the canines and if you want to fill buccal corridors. • Always send actual facial and close-up pictures (with upper and lower arches slightly apart in order to see initial incisal contours) as this will help the lab design a beautiful smile.

2. Ask the lab to return a Wax-up, Prep Indices, Bite Stent and Siltec Provisional Stent as this will ensure easy temporary creation.

3. Make sure to take the stump shade on moist preparations as it affects the final color of the thin veneer and the lab must be able to adjust their color choices (Figure 15).

4. Single veneers are difficult to color match and maintain, as adjacent natural dentition will normally darken over time. If teeth are relatively similar, a single veneer without reduction will always be too prominent.

Encourage patients to place multiple veneers (e.g., multiples of 2, 4, 6, etc. veneers as a minimum). I encourage the use of “Clear Match” for single restorations – ask your Aurum Ceramic laboratory for details.

5. Incisal Reduction is not recommended unless the teeth are naturally too long. However, an incisal wrap is often recommended to make seating easier and to slightly lengthen teeth, unless there is no wear whatsoever. This must be evaluated carefully from patient to patient.

p Figure 1 – Full face Before.

p Figure 2 – Close-up of pre-operative smile.

p Figure 4 – Pre-operative smile – Left – open.

p Figure 5 – Retracted pre-operative smile.

p Figure 3 – Pre-operative smile – Right – open.

p Figure 6 – Retracted pre-operative smile – Right – open.

p Figure 7 – Retracted pre-operative smile – Left – open.

p Figure 8 – Photo selected by patient “mimicking” desired smile.

p Figure 9 – Diagnostic Wax-up.

p Figure 10 – Prep Indices

p Figure 11 – Probe indicating Incisal length.

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p Figure 12 – Prep guide over pre-op model - note how little incisal prep will be needed (if any)

p Figure 13 – Prep Guide over unprepped teeth (pre-op) showing minimal prep needed in order to fabricate Aurum’s Cristal Veneers®

p Figure 14 – Light shaping and contouring.

p Figure 15 – Taking stump shade.

p Figure 16 – Sil-Tech Provisional Stent.

p Figure 17 – Close-up of complete new natural smile – closed.

p Figure 18 – Restored smile open.

p Figure 19 – Post-operative lateral – Right – open.

p Figure 20 – Post-operative lateral – Left – open.

p Figure 21 – Retracted post-operative smile.

p Figure 22 – Retracted post-operative smile – Right – open.

p Figure 23 – Retracted post-operative smile – Left – open.

p Figure 24 – Full face After.

6. Some preparation may be recommended when placing Mandibular Veneers to allow sufficient space, especially in the incisal areas. Carefully consider the Centric bite as well as lateral and protrusive movements.

7. Shade Management

• Due to veneer thickness, it can be difficult to mask out very dark substructures. If the desired shade is more than three shades lighter than existing dentition, opaquing products may be required for the natural tooth and/or the lab can opaque the veneer. In the worst case scenario, preparation of the tooth may be needed to prevent showthrough.• Bleaching before treatment may be indicated (or more opaque bonding cements used to block out dark shades). The lighter the desired shade, the more opaque the veneers must be to hide underlying tooth color if it is very dark.• There are a number of excellent luting resin kits available which offer shade adjustment systems. • Do not use self-curing cements! There are three reasons: o They might darken with time, coloring the veneer. o Most self-curing cements expand on curing and this may cause internal stress and eventually fracture the thin veneers. o Using a light cure cement gives you much more time to remove cement excesses before curing thus making seating a breeze.

Aurum Ceramic offers an excellent “Technical Instruction Guide” for Aurum’s Cristal Veneers® on its website. Go to the All-Ceramic section on the Product Index at www.aurumgroup.com and select Aurum’s Cristal Veneers to view the full range of educational and support materials available for viewing and download.

Restorations fabricated by Aurum Ceramic

Over years of daily practice, I have found that nothing compares to the feelings of satisfaction and accomplishment I can achieve when a patient asks “How did you do that?”

Plan to Watch Dr. Larose’s upcoming Webinar Series!

“Ultra Conservative Minimal-Prep Veneers”A step-by-step guide featuring an actual clinical case and live patient, in four webinars

Includes an on-going email Q&A component with Dr. Larose!

Check for details on availability forOn Demand Download of each webinarin the “Upcoming Courses” off theNEWS & EVENTS Menu at www.aurumgroup.comOR contact the Aurum Ceramic/Classic Dental Laboratories Continuing Education DepartmentAt 1-800-363-3989 (email: [email protected])

Connect with us on @aurumgroupGo to www.aurumgroup.com/usa-aurumtek for complete details!

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SpotlightErnie Wotton, DDS

p Figure 1 – Initial presentation of lower arch – note severe crowding in the anterior.

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Titanium Frameworks – Lighter, Biocompatible and Corrosion Resistant Gary Wakelam, RDT, CDT

The use of titanium and titanium alloys in medical and dental applications has increased dramatically over the past few decades. It all started in the 1960s when Per Branemark discovered the biocompatibility between titanium and bone and applied them to implant design and placement. Today, strides in titanium processing have made this metal a valuable addition to our armamentarium in dental prosthetics.

Titanium has really only been produced commercially for roughly 50 years. Its physical properties (high strength and rigidity; low density and light weight; resistance to corrosion; and low thermal conductivity) have made it a favourite in the aerospace, aeronautical and other high-tech industries. In dentistry, the additional properties of neutral taste and biocompatibility have made it of great interest in producing cast partial frameworks.

The high strength and rigidity of titanium are comparable with other noble or high noble dental alloys yet its low density allows for feather-light substructures (over 35% lighter than chrome castings and more than four times lighter than gold alloys). A pure metal with excellent corrosion resistance, titanium has long been recognized because of its excellent biocompatibility (no allergic reactions). With its lack of metallic taste and low thermal conductivity, patients can eat hot and cold food and drink without the risk of temperature shock. The metal’s modulus of elasticity allows clasp designs that engage deeper undercuts resulting in a more esthetic restoration.

Clear communication between dental practitioner and laboratory technician has always been one of the keys to a successful cast partial restoration. This is no less true with titanium. Our exclusive in-house Computerized Cast Partial Design System is a key aspect in producing cast partials with maximum patient function, comfort and esthetics. Each design is completely customized to meet the individual case situation and your personal preferences.

Full color plots are either sent to you as hard copies or emailed for you to print out on your own color printer. Clearly indicating agreed upon case design, preparations, etc., the plots also make an excellent patient education tool. In addition, every titanium framework is x-rayed for imperfections as part of our extensive quality control systems (actual x-ray sent back to you along with your case).

At Aurum Ceramic, our Cast Partial Teams™ employ and have extensively tested the most advanced technology available to design and produce a wide range of superior titanium and Vitallium 2000 dental prostheses. Their strict attention to detail, along with high quality materials and techniques, results in precise clasp adaptation and retention with each framework. Contact your closest Aurum Ceramic location for full details on the full range of possibilities available in cast partials today.

Titanium Benefits• Totally biocompatible.

• Lightweight (over 35% lighter than chrome castings).

• Precision fit.

• Clasps can be placed in deeper undercuts (more esthetic restoration).

• Low thermal conductivity (no hot or cold temperature shock).

• No metallic taste.

Ernie Wotton, DDS received his BSc at Mount Allison University before graduating from Dalhousie University Dental School in 1990. Following graduation, he opened a private practice in Saint John, NB in 1990. In 1997, he moved to Newfoundland but returned in 1998 to purchase an existing general family practice in Antigonish, NS where he remains today.

Dr. Wotton has completed several cosmetic dentistry courses at the Las Vegas Institute for Advanced Dental Studies (LVI). He continues to pursue Continuing Education at Spear Educational Center in Scottsdale AZ with a specific interest in restorative design. Dr. Wotton is a member of the CDA and NSDA and is a mentor for CerecDoctors.com.

p Figure 4 – Retracted smile Before.

p Figure 2 – Lower arch in 2014 – after 8 years post Invisalign. Some relapse has occurred.

p Figure 5 – Close-up of new smile.

p Figure 3 – Natural smile Before.

p Figure 6 – Full face After.

This female patient first visited our practice in 2005. Her chief concern at that time was the severe crowding of her lower anteriors (Figure 1) although there were many other dental challenges evident. We resolved this issue for her with Invisalign orthodontic treatment (Figure 2) and she became a regular patient of the practice.

Over time, we were able to discuss the additional challenges evident throughout her mouth, beginning with her upper anteriors as a logical “step-by-step’ follow-up to the straightening of the lower anteriors. As evident in Figures 3 and 4, her existing veneers and crowns on her upper arch were in poor condition with recession and decay at the margins. Tooth 2-1 had undergone a root canal and still had a dark root. Tooth 2-4 had a crown over a post and core. It was the failure of this crown, and the discovery that the root of 2-4 was cracked, that finally lead the patient to consider more extensive restoration in early 2014.

We discussed several options initially for restoring 2-4. One of these was a single implant, which she rejected out of hand, especially as her adjacent nine teeth were also crowned/veneered, in poor condition and candidates for eventual replacement. After some deliberation, she elected to proceed with 10 units on the upper arch. We re-cemented Tooth 2-4 back on as a short-term temporary. The Aurum Ceramic AE Team prepared a Diagnostic Wax-up as part of their ACCES System. This was invaluable in allowing the patient to view what her new smile would look like and in creating the provisionals.

On her return to the office, we extracted 2-4, prepared the adjoining teeth as abutments and placed a three-unit provisional bridge. After allowing 10 weeks for this to heal, we prepped her remaining teeth and placed the remaining provisionals. The prep design in this case was somewhat challenging as Tooth 1-5 was extremely dark, Tooth 2-1

had that aforementioned dark root and her thin gingiva.

The Aurum Ceramic AE (Advanced Esthetic) Team carefully crafted a beautiful Contessa All-Zirconia Bridge on teeth 2-3 to 2-5.The remaining teeth were restored with IPS e.max® CAD crowns. The patient has now had her restorations for four months (as per Figures 5 and 6) and is thrilled with the final functional and aesthetic results! She is looking forward to restoring her lower posteriors over the next year.

Ernie Wotton, DDS

Restorations fabricated by Aurum Ceramic.

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“As a dental professional, this patient was troubled by her severely worn dentition and wanted to rehabilitate her bite for cosmetic reasons. Yet as an orthodontist, while her teeth were perfectly straight, she knew she was still grinding her teeth as a bruxer/clencher and saw the evidence of wear, eventually cracking #14 and losing the tooth. This was the tipping point causing her to move ahead with Full Mouth rehabilitation, beginning with her upper arch as soon as possible.

This patient illustrates several important points about treatment planning with Full Mouth cases. When she smiles naturally, the patient has a lot of maxillary display – your typical ‘gummy smile”. This results in challenges when you open the bite – the danger is you will end up with a “toothy and gummy” smile that is certainly not the desired optimal aesthetic end result both patient and clinician are looking for. In this instance, this was remedied by making her lower teeth longer to balance the smile. In addition, we should all bear in mind that opening the smile can also have a dramatic

impact on the overall facial aesthetics of the patient. Opening the vertical dimension can result in a noticeable change in lip posturing, altering the way the lip drapes and often resulting in a patient that looks much younger after treatment.

While a bruxer/clencher, she was completely asymptomatic and did not suffer from any TMJ pain. We started her treatment by taking a full set of diagnostic x-rays and a myobite to determine her comfortable bite position, which showed she was overclosed by 5.4 mm. A Removable Lower Orthotic was placed for 4 months to correct the patient’s jaw alignment and to calibrate proper vertical positioning. After conducting a K-7 neuromuscular study to ensure her new bite was comfortable, Aurum Ceramic prepared a Diagnostic Wax-up as per their ACCES™ system. We prepared and seated her maxillary arch and transitioned to a Fixed Lower LVI Orthotic for eleven months. The maxillary set of temporaries was created from the wax-up from the bite transfer.

CaseSpotlight Dr. Pamela Marzban DDS, FAGD, LVIF

Dr. Pamela Marzban graduated with a Doctor of Dental Surgery (DDS) with Honours/Distinctions from the Medical College of Virginia in 2000. Having grown up in Northern Virginia, she purchased a practice in Burke, VA in 2002 specializing in cosmetic dentistry, advanced implant technology and neuromuscular dentistry. A fellow of the Las Vegas Institute for Advanced Dental Studies, Dr. Marzban has completed Core

curriculum and PAT courses. She is a Fellow in the Academy of General Dentistry, and a member of the American Academy of Cosmetic Dentistry, International Association of Comprehensive Aesthetics, American Dental Association, and Virginia Dental Association. Dr. Marzban is also a clinical instructor at Virginia Commonwealth University and teaches there part time.

The patient allowed me complete freedom on the color and texturing of her restorations but wanted final say on the translucency. Her lower arch was prepared and finished. With both arches I used the Aurum Ceramic Advanced Esthetic (AE) Team® the Prep Indices and Bite Stents. The upper and lower arches were restored with a combination of single IPS e.max® crowns due to existing restorations; IPS Empress® veneers (on #6-8,10-11 and #22-27) as a conservative option as her teeth did not require full crowns; and a custom implant-retained Zirconia abutment and IPS e.max® crown on #14.

As the “After” photo shows, the texturing and translucency on this case is looks amazing. The restorations look truly natural. With a lot of texturing, when the light hits the moisture (i.e., saliva) on the dentition, it really gives the teeth dimension. The porcelain work from the Aurum Ceramic Advanced Esthetic (AE) Team was truly beautiful and really enhanced the final result.”

p Full face Before.

p Retracted view, pre-treatment.

p Close-up of beautiful new smile.

p Close-up of pre-treatment natural smile.

p Retracted view, post-treatment – Note lower restorations are longer.

p Note the texturing and translucency achieved. p Full face After.

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One of the primary areas of dentistry is dealing with orofacial pain on a daily basis. Every kind of tooth pain is, in effect, orofacial pain. I have been to many courses in my career that will keep odontogenic pain completely separate from other forms of orofacial pain which may involve the TMJ, muscles, and head and neck neuralgias. This, though, is a very common mistake as many times odontogenic pain can refer to other parts of the head and neck and vice versa.

What many dental professionals are not aware of, and have not been taught, is the existence of trigger point pathways that exist between the head and neck muscles and the jaws and teeth. Deep tissue structures such as muscle, tendons, TMJ and the dental pulp can all have pain either locally right at their source or refer pain along trigger point pathways. In the past, those of us who have been trained could identify trigger points in the head and neck muscles, would commonly think that these pathways only worked one way.

There is now plenty of evidence that shows that these trigger point pathways are really a two way street. A 2011 JADA article estimates that there are approximately 680,000 teeth that receive endodontic therapy every year when the tooth may not have been the

source of the pain. Likewise, a 1996 JADA article identifies tooth pain as causing or contributing to myofascial pain and TMD. Putting all of this together, a comprehensive and efficient head and neck examination should be a routine part of every dental examination, especially when the patient’s symptoms are any kind of orofacial pain.

NEWS ALERT! Toothaches and Obstructive Sleep Apnea (OSA) Causes TMD Pain! Louis Malcmacher DDS MAGD

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What is a trigger point? A trigger point is a hypersensitive area typically in a muscle which can be found upon examination by applying four to eight pounds of pressure in that muscle for a period of six to ten seconds.

The trigger point pathway would be the pathway from where the trigger point is to the place where the pain is actually felt by the patient. If we press upon that muscle and all of a sudden that pain is felt in a remote site, then we define the patient’s condition as myofascial pain. The trigger point pathway is a two way street – there are many trigger points that may be found in the temporalis muscle that, when activated, the pain is felt in anywhere from the anterior to the posterior upper teeth. Conversely, if there is some pathology with one of the maxillary teeth, this pathway could work from the odontogenic origin and the patient may exhibit pain in the temporalis muscle or around the temporomandibular joints mimicking, causing, or exacerbating TMD syndrome.

Now that you’ve been exposed to the concept of trigger point pathways, this once again emphasizes the fact that dental professionals are not just “teeth mechanics”. Too many dental offices operate like the dry cleaners – patients come into many dental practices and they might as well just take the teeth out of their mouths, drop them off, get them cleaned or fixed and then pick them up later. Of course, they can’t do that because, to make a point more strongly, the teeth are connected to the jaws that are connected to the muscles and all of the structures of the head and neck. They are all connected and you, the dental professional are the only healthcare professional that can connect and treat all of these pieces together.

The same concept is true when it comes to dental sleep medicine. Dentists now have the unique opportunity to be a real partner in providing oral appliance therapy to patients with obstructive sleep apnea, a treatment that physicians need every dentist to provide. Once you understand how to treat frontline TMJ and orofacial pain,

then you will have a very solid foundation for being able to create physiological oral appliances for obstructive sleep apnea. Without understanding the facial muscles, many dentists deliver oral appliances that exacerbate or create orofacial pain which creates a clinical dilemma of trading one serious problem (OSA) with another (orofacial pain). I can’t tell you how many dentists have stopped treating patients with oral appliance therapy because it increases the patient’s facial pain. Frontline dental sleep medicine goes hand in hand with treating patients for orofacial pain.

One other mistake that most dentists make – they have the mistaken impression that the dentist has to know everything about sleep medicine in order to make oral appliances for OSA. What you, as a dental clinician, need to know is frontline OSA treatment – how to screen; how to do a home sleep study; when to refer for CPAP; how to create and deliver physiologic successful oral appliances; how to monitor and evaluate the treatment; and how to properly and fairly bill the patient and/or their medical insurance. Of course, more education is always good but learning how to manage these cases (a dentist’s responsibility) is the essential skill needed for these cases. The American Academy of Facial Esthetics (AAFE) has also pioneered the use of botulinum toxin (Botox) in dental sleep medicine cases.

An excellent orthodontic dental laboratory, like Space Maintainers Laboratories Canada, is also an invaluable resource. Their “Principles of Appliance Therapy for Adults and Children” is the essential 250 page, full-color encyclopedic office reference for Appliance Therapy. It places the latest treatment protocols, diagnostics and therapy techniques at your fingertips for over 300 appliances with hundreds of oral appliance photographs. Depending on your diagnosis, Space Maintainers can assist you in prescribing the optimal appliance from their full range of innovative, advanced DMD and bruxism splints or their wide variety of snoring and mild to moderate obstructive sleep apnea appliances. These solutions are all non-invasive, reversible, and well accepted by patients.

Louis Malcmacher DDS MAGD

Louis Malcmacher DDS MAGD is a practicing general dentist and an internationally known lecturer and author known for his comprehensive and entertaining style. Dr. Malcmacher has served as a spokesman for the AGD and is president of the American Academy of Facial Esthetics www.facialesthetics.org. You can contact him at 800 952-0521 or email [email protected]. The AAFE website is www.FacialEsthetics.org where you can find information about his lecture schedule, live patient Frontline TMJ/Myofascial Pain training, Frontline OSA Therapy training, Botox and dermal fillers training, download his resource list, and sign up for a free monthly e-newsletter.

Plan to Attend

“Frontline TMJ, Orofacial Pain, and Dental Sleep Medicine for Every Practice”with Dr. Louis Malcmacher

For more information and registration, please go to www.FacialEsthetics.org or call 1-800-952-0521 for this exciting live patient course.

Dates subject to change.Please call to confirm course dates.

Depending on your design preferences and the oral conditions of the patient, you can select from Adjustable/Titratable Snoring/OSA Appliances and Non-adjustable Mandibular Repositioners such as the SomnoDent® Sleep Apnea Appliances (Flex, Classic, Lingual-Less)*; The Klearway™ Appliance; TAP® 3 TL; The Adjustable Herbst® Sleep Appliance; The EMA - Elastic Mandibular Advancement® Appliance; The Clasp Retained Mandibular Repositioner or The Mandibular Inclined Repositioning Splint (M.I.R.S.).

All it takes is learning some basic skills to be able to include treating the head and neck muscles with all of the dental treatment that you now provide and then you, in relation to a medical professional, will be the true orofacial pain “specialist” to your patients. Stop ignoring these patients, learn how to do a thorough head and neck examination and find and identify trigger points, learn some frontline TMJ and myofascial pain techniques, learn frontline OSA treatment, and you will be amazed at how much better your treatment outcomes will be and how fast your practice will grow.

*SomnoDent® appliances are manufactured by Aurum Ceramic Dental Laboratories Co. under licence from SomnoMed Limited and SomnoMed Inc.

Over my 36 years of technical experience I have seen many, many thousands of different variations of tooth preparations. Unfortunately, when dealing with today’s high strength all-ceramic materials and, the demands placed on dental practitioners by esthetically aware patients, prep design has become more important than ever before.

All ceramic restorations have always had specific manufacturer’s preparation guidelines to prevent fracture and failure. Yet, for some reason, these guidelines are not always followed to the letter. The result of trying to “bend the rules” is almost always the same: unhappy disgruntled patients and frustrated clinicians. Certainly, laboratories must share the blame here – but normally it is because they accept a prep design that “might work”, although it is often far short of the minimum acceptable guideline in one way or another. Extensive research has proven that these high strength all ceramic restorations will work if the preparation is correct. Whether Lucite glass, Lithium Disilicate, Zirconia Monolithic or Zirconia substructures with layered porcelain – all need proper prep designs to succeed in the mouth.

At the same time, it is important to realize that all-ceramic is NOT the optimal choice for a number of procedures, no matter how you prep them: porcelain fused to metal for long span bridges due to bite related issues or where long span all ceramic bridges are not recommended; precision attached partial dentures; keyway /slot splinting of units for path of insertion reasons; PFM’s over implants and a number of others. The material must still be able to stand up to the stresses involved with the case and indication.

The common reasons for restoration failure are equally well-known:

• Micro cracks created during occlusal adjustments • Restoration is thinner than manufacturer’s guidelines • Micro cracks created during time of fabrication in the laboratory • Inaccurate fit of restoration • Inaccurate scanning / impressing • Excessive load during try in to check occlusion

Note how many of these can be traced back to trying to meet inadequate preparations (for a variety of reasons, including the impression) or due to forces caused by that design. A failed restoration due to any of these issues becomes costly, not only for your dental practice but also for the laboratory. Then there is the disappointment and inconvenience to the patient, which may impact on your future dealings. We all share in the “costs”, and reap the “benefits”, when prep design guidelines are followed a little more closely.

Ask for the Aurum Ceramic Product Technical Overview (or go to www.aurumgroup.com/c-productoverview).

Effective Communication Between Clinician and Technician

Let’s talk about Tooth Preparation Design!Ulf Broda, CDT, RDT, LVIFManager, Neuromuscular and Comprehensive Aesthetics, Aurum Ceramic

Ulf Broda RDT, CDT, LVIF started his journeyin the dental industry in 1977 by apprenticingin Vancouver BC, Canada. A Senior DentalTechnician with over 36 years’ experience, he has been employed by Aurum Ceramicfor the past 22 years. Registered and certifiedas a Dental Technician in both Canada and theUSA, with many years’ experience in full mouthreconstruction, Ulf is a member of AACD, IACA,LVI, and ICCMO and has taken almost all of thecourses at the Las Vegas Institute for AdvancedDental Studies. This allows him to communicate and consult with clients in all aspects of pretreatment planning, smile designs, full mouth reconstruction, orthotics (removable or fixed), transferring the bite and maintaining the correct bite – and liaise between dental office and technicians for a complete understanding of the prescription.

This handy technical two-sided guide provides a summary, product-by-product, of key product benefits, indications, recommended shade guides, bonding/cementation and most importantly, clear prep tips and Manufacturer’s prep guidelines/diagrams for all the popular procedures today.

Here is a brief summary by product for some of these as a reference point:

IPS Empress® Esthetic Veneers - 1 mm shoulder chamfer, minimum 7 tenths facial reduction, 1 mm incisal reduction, rounded internal edges.

IPS Empress® Esthetic Anterior Crowns (and Bicuspids) - 1 mm shoulder chamfer, minimum 1 mm facial reduction, 1 mm incisal reduction, rounded internal edges.

IPS e.max® Veneers - .5mm shoulder chamfer, minimum .5mm facial reduction, 1 mm incisal reduction, rounded internal edges.

IPS e.max® Full Crowns - 1 mm shoulder chamfer, minimum 1 mm facial reduction, 1. 5 – 2 mm occlusal reduction, rounded internal edges.

IPS e.max® 3-unit Bridges up to the second bi-cuspids - 1 mm shoulder chamfer, minimum 1 mm facial reduction, 1. 5 – 2 mm occlusal reduction, rounded internal edges, minimum 3mm occlusal/gingival height for connectors.

Monolithic Zirconia Full Crowns and Bridges - 1 mm shoulder chamfer, minimum 1.5 mm facial reduction, 2 mm occlusal reduction, retentive proximal walls, minimum 4mm occlusal/gingival height for connectors.

Zirconia Substructures Full Crowns and Bridges with layered Ceramic Porcelain - 1 mm shoulder chamfer, minimum 1.5 mm facial reduction, 2 mm occlusal reduction, retentive proximal walls, minimum 4mm occlusal/gingival height for connectors.

Porcelain Fused to Metal Full Crowns and Bridges - 1 mm shoulder chamfer, minimum 1.5 mm facial reduction, 2 mm occlusal reduction, retentive proximal walls, minimum 4mm occlusal/gingival height for connectors.

So that’s a quick over view of suggested preparation guide lines. While it certainly isn’t easy determining the correct amount of reduction for the type of preparation being done; here are a few helpful product suggestions shared with us by our clinicians:

• Reduction tabs (Kerr) ranging from .5mm – 2mm. • Depth cutting burs (Brasseler) - determining correct amount of reduction, from .5 mm – 1mm. • PrepCheck™ (Common Sense Dental) prep-marking system - special coating marks the tooth in areas that need to be reduced.

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Onlays

For Aurum Tandem Bridge

Anterior Inlay Bridge

Posterior Inlay Bridge

Stacked Ceramics over Metal

Preparation must include 180° or 360°

beveled shoulder margin

• reduce anatomically for full crowns.

• provide enough room to allow adequate

strength. Suggested 2 mm occlusal

clearance.

Anterior PFM Crown

Posterior PFM Crown

Premise™ Indirect

The ideal nanohybrid material for creating restorations that age, feel, wear, function and

look like a natural tooth. Opalescent appearance that virtually replicates natural enamel

like no other restorative material. Trimodal curing (light, heat and pressure) achieves

over 98% material conversion, as compared to 60 – 70% gained with light–cure only

materials. Twelve years of positive clinical studies and field data and tens of thousands

of successful restorations placed since 1996.

Recommended Shade Guide: Vita Lumin, Vitapan 3D-Master.

Bonding: Must be bonded using dual cured resin cement with companion enamel/dentin bonding agent.

Princess®

Supplies 360° low-fusing all ceramic margins on high noble substructure.

Full 1 – 2 mm of beautiful thermo-pressed ceramic past the finished metal coping

for optimal esthetics. Fits more precisely and stronger than hand-layered alternatives.

Can be utilized for posterior inlay bridges.1

Recommended Shade Guides: Ivoclar Chromascop®, Vitapan 3D-Master, Vita Lumin.

Conventional Cementation: Use any conventional PFM cement (Glass Ionomer, resin ionomer, adhesive resin cement,

Zinc Phosphate, etc.) or can be bonded with Multilink or Panavia F (follow manufacturer’s directions).

1 Up to six unit anterior or posterior bridges.

Arizona®

Most lifelike PFM available. High noble framework cast thin for beautiful incisal edge

and superior marginal integrity. Cast coping stronger than any gold foil. Collarless

design, no metal display with porcelain butt margin. Normal tooth preparation

(doesn’t require deep chamfer margins). Use any conventional cement.

Recommended Shade Guides: Vita Lumin, Vitapan 3D-Master, Chromascop®.



1 Up to six unit anterior or posterior bridges.

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NaturalTemps® Milled Provisionals

Most esthetic provisionals available today. Can also serve as a high-quality Diagnostic

Tool and Treatment Guide. CAD/CAM milled for virtually perfect fit and easy seating.

Can be crafted directly from your digital impression files – or normal impressions and

models. Outstanding flexural strength (95 MPa) for long-lasting durability – temporize

even full mouth reconstruction and implant cases with perfect confidence.

Patient can perform daily functions without interruption, even over extended periods.

Recommended Shade Guides: For basic shades, use the Vita Lumin or Vita 3D Master Shade Guides.

Standard temporary cementation (follow manufacturer’s directions).

New Age Composites - Adhesively Bonded

Pressable Ceramics Over Metal - Conventionally Cemented

Fixed Price Porcelain Fused to Metal - Conventionally Cemented

Temporization

All-Ceramic Restorations - Conventionally Cemented (cont.)

Opalite® Spectrum

Opalite® Basic - Recommended for Molars

Category-best esthetics in full contour All-Zirconia Crowns! Precision milled for perfect

fit and easy seating. Offers full spectrum of shades, and amazing translucency.

Basic anatomy and characterization. Traditional, conservative cast gold preparation.

Ideal for bruxers and grinders.

Opalite® Plus - Recommended for Bi-Cuspids

Porcelain facing fused to Zirconia. Offering basic anatomy and characterization along with

internal and external staining. The next step up for the more esthetically conscious patient.

Opalite® Ultimate - Recommended for Anteriors

The perfect esthetic zirconia-based anterior solution. Precision CAD/CAM milled yttria-

stabilized Zirconium core. New generation veneering ceramics layered over substructure

for superb esthetics. Advanced anatomy and characterization along with internal and

external staining as prescribed.

Recommended Shade Guides: For basic shades, use the Vita Lumin, Vita 3D Master or Chromascop Shade Guides.

For bleached shades, use the Chromascop Bleached Shade Guide, Vita 3D Master Bleached Shade Guide or Illuminé Shade Guide.



PROCERA® AllCeram

A densely sintered Zirconia oxide coping ensures high biaxial strength, optimal fit,

non-porosity and remarkable esthetic qualities. Translucent coping is combined with

a porcelain formulated to make the most of the copings inherent esthetic potential.




Lava™

Ideal for 3- and 4-unit bridges, Lava’s precision CAD/CAM system produces zirconium

oxide frameworks with outstanding marginal fit. Preparations require removal of less tooth

structure, and cementation can be accomplished using proven, conventional techniques.




AurumTek® Custom Abutments

Combines the natural beauty of shaded Zirconia with the strength of Titanium.

CAD/CAM milled and compatible with a wide variety of implant systems, AurumTek’s

full palette of shades and perfect emergence profiles ensure a seamless transition

between abutment and crown.

Recommended Shade Guides: For basic shades, use the Vita Lumin, Vita 3D Master or Chromascop Shade Guides.

For bleached shades, use the Chromascop Bleached Shade Guide, Vita 3D Master Bleached Shade Guide or Illuminé

Shade Guide.



Aurum’s Cristal Veneers®

Ultra thin. Ultra conservative. Ultra beautiful. Combination of proven thermo-pressing technology and exclusive glass-ceramic materials provides high strength and precise marginal fit. Can be as thin as .3 mm. Adhesively bonded to tooth structure.Recommended Shade Guides: For basic shades, use the Chromascop or Vita Lumin Shade Guides.For bleached shades, use the Chromascop Bleached Shade Guide or Vita 3D Master Bleached Shade Guide.Bonding: Must be bonded using dual cured resin cement with companion enamel/dentin bonding agent.

Light cure only resin cement can be used for veneers.

Product Technical OverviewAll-Ceramic Restorations - Adhesively Bonded

Anterior Posterior Preparation

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Anterior All-Ceramic Crowns

Posterior All-Ceramic Crowns

Veneers

• chamfer lingual preparation.• interproximal contact intact.• 0.5 mm labial gingival finishing line.

• overlap of incisal edge recommended.• long bevel lingual preparation.• lingual butt margin provides greatest strength as butt shoulder.• all line angles rounded, preparation smooth.

Anterior 3-Unit Bridges• heavy chamfer or shoulder preparation of 1 mm at a 90° - 110° angle (butt joint margin).• minimum 4 mm x 4 mm connector joints recommended.• maximum Pontic Span: 9 mm Posterior to Canine or 11 mm Anterior.

CAD/CAM Prep Anterior

CAD/CAM Prep Posterior

IPS Empress® Esthetic Advanced Cosmetic (Cutback Technique)IPS Empress® Esthetic Regular Esthetics (Stain & Glaze)Individually characterized ceramic core (in all Vita* and Chromascop® shades) covered with layered incisal and transparent materials. Beautifully esthetic restorations. Accurately reproduces light transmission and translucency found with natural teeth. High flexural strength values. Tensile strength of 200 MPa.Recommended Shade Guides: Ivoclar Chromascop®, Vita Lumin, Vitapan 3D-Master.Bonding: Must be bonded using dual cured resin cement with companion enamel/dentin bonding agent. Light cure only resin cement can be used for veneers.* Vita is a registered trademark of the Vita Zahnfabrik Company

Lava™ UltimateTough, resilient and durable resin nano ceramic material. High flexural strength (200 MPa). Less wear to opposing dentition than glass ceramics. Elastic modulus comparable to dentin - better absorbs chewing forces and reduces stress to the restoration (especially advantageous for crowns over implants). Easy to adjustand re-polish to achieve ideal occlusion — right in your office. Backed by a 10-year

limited manufacturer’s warranty from 3M ESPE.Recommended Shade Guide: Vita Lumin, Vitapan 3D-Master.Bonding: Must be bonded using dual cured resin cement with companion enamel/dentin bonding agent.

Aurum Tandem® BridgeConservative, proven replacement of one or two posterior teeth. Tandem bridges feature the strength (900 MPa) and fit of a Zirconia framework, completely surrounded with composite material for natural esthetics, wear resistance and the ability to bond to the prepared teeth. Indicated for up to two pontic posterior bridges (depending on clinical situation), Crowns (all teeth through second molar) and Inlays/Onlays (all teeth).Recommended Shade Guides: Vita Lumin, Vitapan 3D-Master.Bonding: Must be bonded using dual cured resin cement with companion enamel/dentin bonding agent.1 Up to two pontic bridges (depending on clinical situation). Crowns (all teeth through second molar)

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All-Ceramic Restorations - Conventionally Cemented

IPS e.max® Advanced Cosmetic (Cutback Technique)IPS e.max® Regular Esthetics (Stain & Glaze)IPS e.max® CADUnites latest in CAD/CAM technologies with high performance, monolithic lithium disilicate glass ceramic. Incredibly precise, durable, and esthetic solution for single anterior and posterior all-ceramic crowns. Flexural strength of 360-400 MPa. Traditional all-ceramic preparation. Recommended Shade Guides: Ivoclar Chromascop®, Vita Lumin, Vitapan 3D-Master.Bonding: Must be bonded using dual cured resin cement with companion enamel/dentin bonding agent.Conventional Cementation: Use any conventional PFM cement (Glass Ionomer, resin ionomer, adhesive resin cement,

Zinc Phosphate, etc.) or can be bonded with Multilink or Panavia F (follow manufacturer’s directions).1 Up to 3 unit anterior bridges.

1Cut-Back Technique

Stain and Glaze

Zeno® Tec Unique adaptive scanning process ensures outstanding accuracy of < 20 μm. Larger Zirconia disk allows precision CAD/CAM milling of more extensive substructures than possible with competing methods. Frameworks “hard sintered” for 12 hours leading to final flexural strength of 1300 MPa. New generation veneering ceramics either pressed or layered over substructure for greater fracture resistance and truly superior final vitality and esthetics.Recommended Shade Guide: For basic shades — Vita Lumin, Vitapan 3D-Master, Chromascop Shade Guides.For bleached shades, use the Chromascop Bleached Shade Guide, Vita 3D Master Bleached Shade Guide or Illuminé Shade Guide.Conventional Cementation: Use any conventional PFM cement (Glass Ionomer, resin ionomer, adhesive resin cement,


Zirconia substructure

New generation veneering ceramic

NEVADA, UTAH, NEW MEXICO AND ARIZONA:1-877-254-5334 WASHINGTON, OREGON, MONTANA AND IDAHO: 1-800-423-6509 OTHER NORTH AMERICAN LOCATIONS:1-800-661-1169

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Aurum’s Cristal Veneers®

Unmask the natural beauty of your patient’s smile!”

For striking esthetics with minimal tooth reduction, look no further than Aurum Ceramic’s exclusive, ultra conservative Cristal Veneers®!

• All the benefits of Pressed Glass Ceramics - with minimal preparation.• Can be as thin as .3 mm, based on your precise preparations.• Exclusive veneering techniques allow for subtle changes in customized contour, fit or shade.• Full palette of shades available. • Combination of proven thermo-pressing technology and exclusive glass-ceramic materials offer high strength and precise marginal fit.• Adhesively bonded to tooth structure.

Visit www.cristalsmile.com or Call TOLL FREE

Ultra ThinUltra ConservativeUltra Beautiful

“I love the life-like esthetics, highlights and incisal translucency Aurum Ceramic reliably delivers time after time.” Dentistry courtesy of James W. W. McCreight, DDS, Steamboat Springs CO, LVI Clinical Instructor.




Connect with us on @aurumgroup

Go to www.aurumgroup.com/usa-functionalappliances for full details Connect with us on @aurumgroup

Functional Appliances from Space Maintainers –The Perfect Solutionfor Class II Challenges!

Why Functional Appliances?• Correct a variety of “Class II” situations reliably and predictably.

• Usually used as a first stage of treatment (in a growing patient with a significant disharmony between the upper and lower jaws).

• Typically passive, tooth-borne without active components (i.e. springs, screws).

Twin-Block Appliance

Why Space Maintainers For Your Functional Appliances?• Industry’s widest range of exceptional functional appliances, created with the finest quality materials.

• Each appliance carefully matched to individual patient needs, comfortable and easy to maintain, inconspicuous and aesthetically sound.

• Always ready to help with these popular designs - and many more - or to take on your special or custom requirements.

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Several months ago, we started a three-part journey together: discovering that the best tool to communicate with our patients is simply asking the right questions. In part one, we explored how we tend to assume that we know what the patient is thinking or feeling before they tell us. We reviewed how we often end up actually burying the conversation through this behaviour. In part two, we explored how to co-diagnose with a patient, helping them to discover their own problem instead of us automatically giving them a solution to a challenge before they acknowledged they had it. In this final article, we will deal with asking the questions that actually allow us to uncover each patient’s “propelling forces”.

What do I mean when I say “propelling force”? Think of any propeller. In all cases, whether a boat propeller or an airplane propeller and so on, it moves something forward. Now consider: what are the things that would move your patient forward to do dentistry? These things are their propelling forces. Ninety nine percent of the time they will be what the patient wants. Psychologists tell us that 80 percent of our buying decisions are based on emotions and 20 percent on logic. People buy what they want, not what they need. However, in dentistry, we were trained to tell the patient what they need.

By understanding human nature, we can simplify our treatment presentation into basically three distinct areas as follows: Mr. Patient these are all the things that you told me you wanted and that were important to you (wants). Here are the treatment options (which we learned in part two) to help you get those things that you said you wanted (options). Now, let’s see how we can make those affordable for you (the decision). Easy, right?

How do we get the patient to tell us what they want? First, use open ended questions. You want to make sure to get the patient to talk and tell their story. That story is the most important thing to them. In traditional new patient interviews, we usually ask them, “does anything hurt”, “how often do you brush and floss”, and then we go over their medical history. If we change our questions to be more open ended, we might get different answers. Try questions like:

“How can we help you today?” “Have you had any dental work done in the past?” “What did you like or not like about your past dental experiences?”

Of course, these are just core questions we start with. We also have to learn to ask the follow-up questions that come after those ice-breaking

questions. This is where we use our second important tool - learning to read our patients. Remember, up to 93 percent of our day-to-day communication is actually non-verbal. We need to learn to read that communication. Non-verbally, with their emotions and body language, patients will tell us what is important to them.

Finally, we need to master reflective listening. This involves repeating back to the patient what you heard them say and then turning any objections into an objective. Here’s an example:

Team member: So in your previous dental experiences what did you like or dislike about those experiences?

Patient: “Well one time the dentist was drilling on my tooth and I started to feel it and I tried to tell them but they just kept drilling.”

Team member: “I am so sorry you had that kind of experience. So if I am hearing you right it is very important to you to have pain free procedures.”

Patient: “Yes, I don’t want that to ever happen again.”

At this point in the conversation, it’s very important to avoid “over talking”. We tend to want to go on and on about how we will always make sure they are comfortable, we promise they will never feel anything and blah, blah, blah. They just need to know that you heard them and understand their feelings.

In conclusion, if you are asking the right questions in the new patient interview, you can easily walk out of the consult room with four or five propelling forces. It is very important that we hand those off when we are telling the patient’s story to the Doctor. It is important that we emphasize to the Doctor that “it is very important to Mrs. Patient that she have pain-free procedures.” Then the Doctor will know it is a critical factor in their conversations with that patient. It is also just as important for the Doctor to repeat back the patient’s propelling forces while giving treatment options. As a patient, trust is being built each time they hear back what was important to them.

At this point, you have probably caught on that I am pretty passionate about asking questions. However, I am even more passionate about listening to the patient’s answers - because you care and want to understand them. Remember, the number one way to increase treatment acceptance is to gain trust. That trust is gained through a relationship and I believe that relationships are created through listening. But you have to ask first!

Questions arethe Answers (Part 3) Sherry Blair, Dental Management Consultant

Plan to Attend

“Creating Patient Satisfaction: Productive Team Meetings”with Sherry Blair

For more information or courses in your area, check out “Upcoming Courses” off the NEWS & EVENTS Menu at www.aurumgroup.com or contact the Aurum Ceramic Dental Laboratories Continuing Education Department at 1-800-363-3989 or email: [email protected].

Dates subject to change. Please call to confirm course dates.

As Director of the Dynamic Team Program at the Las Vegas Institute, Sherry Blair shares her more than 37 years of experience managing each and every system within the dental practice. Sherry has combined her acquired knowledge and personal experience to create an inspired, effective and motivated curriculum that refines the systems surrounding the patient’s total experience in a dental practice. Sherry’s extensive exposure to most forms of practice management and dental systems, as well as her strong focus on patient satisfaction, make her uniquely qualified to enhance the effects of any dental practice.

SPOKANE1320 N. Howard, Spokane, WA 99201-2412(509) 326-5885 Toll Free [email protected]

Visit our redesigned website at www.aurumgroup.com Connect with us on @aurumgroup

Brilliant Artistry... World Class Technology... Ultimate PerformanceFor aesthetically sensitive cases, no materials perform like IPS e.max® and IPS e.max® CAD. No other laboratory can match Aurum Ceramic® in making the most of your Advanced Cosmetic restorations.

> A perfect fit in your practice... for strength, precision and aesthetics throughout the mouth.

> Beautiful, durable all-ceramic restorations - Crafted by the leader in Comprehensive Aesthetic and Implant Dentistry.

> Unique optical techniques create the ultimate esthetic result.

> Comprehensive Integrated Digital Workflow and Solutions that simplify the restorative process - from initial impression to final restoration.

> Indicated for everything from single units to full mouth aesthetic cases. IPS e.max® is also a great choice for 3 unit anterior bridges (from 2nd bi-cuspid forward).

Beauty and Precision -For EveryIndication!





Documents

Making - Aurum Group · Let’s talk about Tooth Preparation Design! ... Website registration with full details coming soon ... Clinical/Restorative Outcomes and Superior Profitability