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5/9/2019
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SMART PRACTICES FOR YOUR PRACTICE
Todd Snyder, DDS, FAACD, FIADFE, ASDA
Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Former Faculty, UCLA Center For Esthetic Dentistry
Speaker, Catapult Education
LEGIONpride.com, Online Training Challenge for Dentists
Entrepraneur, 2 Software Companies, Author/Lecturer, Race Car Driver
Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA
Aesthetic Dental Designs®
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Write It Down!
Why Are YOU Here?
—Albert Einstein
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INSANITY
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• a d d fadf jas
What Do YOU Want?
Write It Down!• Better Staff
• Expertise/Title
• Popularity/Awareness
• Technology
Will Your Why Get You What You Want?
More Patients, Money…
Power of Questions
Getting What You WANT Does What?
!
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—Albert Einstein
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INSANITY
Lets Do Something DifferentToday?
Today
90 Days
Please Turn On Your Cell Phones
INSTAGRAM@toddsnyderdds@toddsnyder1@legionpride
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Lecture Handout (iPhone Users)
Lecture Handout
www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers
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Digital Handouts
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@toddsnyderdds @legionpride
Better Business
Efficiency and Increase Practice Income
How to find tooth decay.
A beautiful composite for making teeth look amazing, FAST!
Elective dentistry & whitening to increase our production
Indirect material use to make life easy
Today?
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YOU SPEND MOST OF YOUR TIME WHERE?
Ditch Digger….
…..Down In The Mouth
• Many dentists get focused on there own skills, techniques and utilization of modern dental service technology.
• Most dentists do not poses any staff training protocols.
• Most dentists do not have any formal business training.
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THE FOUNDATIONConsumer/Patient Impression• Why YOU?
• They perceive you are?
• Will they go somewhere else for other services?
• Do they think you are capable of providing what they want?
• How can you alter their perception?
• What is your brand image?• Your office appearance?• Website?• Your ads?• Your social media?
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Typical Modern Dental Technology. ROI?…
Faster Hole Digger…
We often train on materials and techniques. Why?
We focus on getting a new credential or title. Why?
So How Do We Get the Whole Team and Office to be more Efficient?
Employee Overhead/TEAM?
Procedures/Consistency?
New Patients/Patient Retention?
= Productivity
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See more people why?You want to see more people and dig more holes?
Define your vision & goalsVision-is your why or what you want to achieve
Everyone’s is different what is yours?
Research shows that people who right down their vision and goals are more likely to accomplish them.
Goal-is a specific target to achieve something
Write down your vision and goals for work, home, and retirement
How do you define your success and is there a vision and goals to get there?
-Money?
-Free family time?
-Net worth?
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Follow these guidelines to setting SMART goals and you will be surprised at what you can do:
• Specific. Your goal should be clear and easy to understand. ...
• Measurable. A goal to “lose weight” is not enough. ...
• Attainable. Before you can add a number, you have to know how high or low you want to go. ...
• Relevant. ...
• Time-bound.
An overwhelming majority of dentists report staff-related issues as the
No. 1 stressor in their practices
Source: American Dental Association (ADA)
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97% of offices don’t train.
POOR TRAINING OPPORTUNITIES FOR EMPLOYEES
3X more likely to leave
Source: Harris Interactive Poll
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NEGATIVE IMPACT ON MORALE2
0% 5% 10% 15% 20% 25% 30% 35% 40%
Too busy
Staff not interested
Too expensive
No quality training
Source: American Academy of Cosmetic Dentistry, The Digital Dentist, & All-Star Dental Academy 2014 Survey
Training Barriers
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STRESSFUL!3
AN OVERWHELMING MAJORITY OF DENTISTS REPORT STAFF-RELATED ISSUES
AS THE NO. 1 STRESSOR IN THEIR PRACTICES
Source: American Dental Association (ADA)
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Technology Online
• Efficiency 24/7
• Accountability
TIP
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Unit 1 Introduction Rapport
Unit 2 Foundation of Rapport
Unit 3Fundamental Techniques in Handling People
Unit 4 Six Ways to Make People Like You
Unit 5 Mirroring & Matching
Unit 6 Outcome of Calls
Unit 7 How to Build Rapport
Module 5 Rapport 2: Personality types
Unit 1 The Know-it-All
Unit 2 The Storyteller
Unit 3 The Easy Peasy
Unit 4 The Rusher
Unit 5 The Informationalist
Unit 6 The Nervous Nelly
Unit 7 The Indecisive
Unit 8 The Price Shopper
Module 6 Rapport 3: Advanced rapport
Unit 1 Empathy
Unit 2 How Long to Build Rapport
Unit 3 VIP Process
Unit 4 Positive Language
Unit 5 Elements of the Rapport Process
Unit 6 Phone Success Quiz #02
Module 7 Engage: Foundation
Unit 1 Introduction to the Engage
Unit 2 What is Engage
Unit 3 Proactive v. Reactive Scheduling
Unit 4 GREAT vs. EAGER Calls
Module 8 Engage: Elements of engaging the patient
• 14 Modules
• Quizes
• Exam
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• 13 Modules
• Quizes
• Final Exam
Module 5 Working with Emergencies
Unit 1 Emergencies
Unit 2Scheduling Quiz #01
Module 6 Broken & Changed Appointments
Unit 1 Introduction
Unit 2Broken Appointment Policy
Unit 3Handling Broken Appointments
Unit 4Broken Appointments COSTS
Unit 5What patients must know
Unit 6Important Points
Module 7 Confirmations
Unit 1 Confirmations
Module 8 Early and Late Patients
Unit 1Early and Late Patients
Unit 2Scheduling Quiz #02
Module 9 Next Appointment Updates
Unit 1Next Appointment Updates
Module 10 Patient Reactivations
Developing 40
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1. Telephone Skills
2. Customer Care Protocols/Scheduling
3. Team’s Role/Training
4. Resource Library
5. 24/7
6. MBA
97% of offices don’t train.
(954) 323-2220
Inquire with “Heather”
So Your Trained..
• Attention Spans Have Dropped
• People Want Immediate Gratification/Results
• Post Cards, Mailers, Yellow Page Ads, Commercials…..are dying.
• Who are you?
• Why you?
• What do you offer?
• EMOTION…
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Remember The Old Appointment Book?
How LONG Did It Take To Answer A Question About Balances, Forgotten
Appointments?
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415-969-7695
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TIP
• VOIP Phone System Integrates with your existing dental practice management software (DPMS)
• Dentrix
• Dentrix Ascend
• Eagle Soft
• Easy Dental• SoftDent
• Practice Works
• Mac Practice
• Open Dental
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WEAVE IS THE BEST SOFTWARE TOOL I OWN• IT LETS ME DO MORE IN LESS TIME THAN WHAT IT WOULD TAKE THREE PEOPLE TO DO IN AN HOUR.
• IT REPLACES YOUR EXISTING PHONE WITH A VOICE OVER INTERNET PHONE THAT ATTACHES TO YOUR PRACTICE
MANAGEMENT SOFTWARE.
• IT GIVES YOU THE ABILITY TO CUT YOUR PHONE BILL AND BE REPLACED WITH A MODERN PHONE PLATFORM THAT
ALLOWS YOU TO.
• TEXT YOUR PATIENTS
• RECORD ALL PHONE CALLS
• AUTOMATED APPOINTMENT REMINDERS, FOLLOW-PS, POST-OP NOTICES, BIRTHDAY GREETINGS, AND MORE
• COLLECT BALANCES INSTANTLY VIA TEXT
• SEE UNSCHEDULED PATIENTS AND HAVE THE ABILITY TO INSTANTLY SEND AUTOMATED TEXT MESSAGES TO FILL GAPS IN
THE SCHEDULE
• NEWSLETTERS AND PROMOTIONS
• SO MUCH MORE….. YOU HAVE TO GET A DEMO IT IS AMAZING!!
• THE COST IS TYPICALLY THE SAME AS YOUR EXISITING PHONE BILL BUT YOU GET RID OF YOUR
PHONE, FOR THE SAME COST YOU REPLACE IT WITH SOMETHING BETTER THAT MAKES MONEY!
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DO YOU WANT MORE NEW PATIENTS?
Are you still diagnosing with this??
50%
accurate
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PATHOLOGY DRIVEN DIAGNOSTICS
RADIOGRAPHIC ANALYSIS
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Since 1896
PORTABLE
LIGHT WEIGHT
INEXPENSIVE
RUGGED
HOW MANY X-RAY UNITS DO YOU
HAVE AND NEED?
TIP
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DIAGNOSE
Is it thru conventional radiographic analysis?Approximately 25% demineralization must occur to see a cavity on a
conventional radiograph. Equates to 40-60% demineralization on the tooth
surface. Radiographs miss 70-80% of occlusal cavities.Digital radiographs provide the ability to manipulate image size and appearance.
67%
accuracy
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DRIVES
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Thru intraoral photographic interpretation?
How do you diagnose decay??
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FLUORESCENT TECHNOLOGIES
What fluoresces in fluorescent-based technologies?
• Bacterial porphyrins (bacterial breakdown product),
• Stain,
• Tartar,
• Food debris
All fluoresce under the wavelengths used in most caries detection devices, whether or not caries is present.
Lussi A , Imwinkelried S, Pitts N, Longbottom C, Reich E. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. Caries Res 1999;33(4),261–266.
Lussi A, Hibst R, Paulus R . DIAGNOdent: an optical method for caries detection. J Dent Res 2004;83C, C80–83.
Verdonschot E H, van der Veen M H. Lasers in dentistry 2. Diagnosis of dental caries with lasers. Ned Tijdschr Tandheelkd 2002;109(4), 122–126.
Konig K, Flemming G, Hibst R. Laser-induced autofluorescence spectroscopy of dental caries. Cell Mol Biol (Noisy-le-grand) 1998;44(8), 1293–1300.
Alwas-Danowska HM, Plasschaert AJ, Suliborski S, Verdonschot EH. Reliability and validity issues of laser fluorescence measurements in occlusal caries diagnosis. J Dent 2002;30(4):129-34.
Rechmann P, Rechmann BM, Featherstone JD. Caries detection using light-based diagnostic tools. Compend Contin Educ Dent. 2012;33(8):582-4, 586, 588-93; quiz 594, 596.
TIP
CariVu Fiber Optic Transillumination
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CariVu: Transillumination
• Near Infrared light…no radiation
• Enamel appears transparent or light
• Porous lesions appear darker by trapping and absorbing the light: these include cracks and caries
• Video capture….live scans
• Stored in Dexis, excellent for communication to patient and yes…to insurance companies
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With proximal surfaces, one can identify
where the lesions are
buccally and lingually
Utilizing CariVu
For identifying cracks, and to a certain
level, the severity of the cracks
Utilizing CariVu
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Allows superior interproximal decision making
regarding Watching, Follow-up, Infiltrating, Drilling
Utilizing CariVu
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BITEWINGS VERSUS
CARIVU
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•
•
•
•
EASILY
DIAGNOSING 5X
MORE DECAY
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TIP
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Minimally Invasive Burs
0512C1300F0710C 0116C
TIP
FREE DISPOSABLE SINGLE USE DIAMONDS
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TIP
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Crystal Structure DiagnosticsThe Canary System Detects Cracks & Cavities not
Visible on X-rays
+ Around & beneath intact margins of fillings & crowns
+ Under sealants (including opaque sealants)
+ On proximal surfaces
+ On smooth surfaces, pits & grooves
+ Around orthodontic brackets
Measures tooth structure breakdown, allows for early
treatment
+ Restore conservatively
+ Remineralize back to health
+ Seal with confidence
Research claims validated by 60+ papers
15+ case reports & 2 FDA CFR 21 clinical trials
The Science Behind The Canary System
• Pulses (2 Hz) of laser light hit the tooth surface.
• Tooth glows (Luminescence, LUM) and releases heat (Photo-Thermal Radiometry, PTR).
• Defective tooth crystal structure affects the retained heat and luminescence signatures.
➢Energy Conversion Technology
Temperature
increase < 1oC
not harmful
• Detected signals reflect the tooth’s condition.
• Detects 50 micron lesion up to 5 mm below the surface.
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Delegated Scanning & Whitening Assistant
Sensitivity & Specificity Study: University of Texas October 2012
Study Design• 20 tooth surfaces selected with
range of clinical conditions from healthy to early caries
• Visual ranking by 2 dentists • Canary Scan• DIAGNODent• Polarized Light Microscopy used as
the gold standard to confirm presence of lesion & depth in that section
Caries Detection Method Canary System DIAGNODent
Sensitivity 100% 18%
Specificity 100% 100%
Spearman Correlation with Lesion Depth
.84 .21
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Canary is Superior to X-Rays for Proximal Caries DetectionJan J et al. Caries Res 2014;48:384–450 DOI: 10.1159/000360836
Objective:
To compare the accuracy of The Canary System, ICDAS-II and bitewing radiographs in detecting proximal caries
in vitro.
Methods:
ICDAS-II (Direct Visual Examination): Blinded examiners ranked 100 proximal surfaces using ICDAS-II by
direct visual examination of the surfaces
Manikin mouth models: The teeth were then set in manikin mouth models, creating contacting proximal
surfaces that very closely resemble in vivo situation.
Histological validation: All surfaces were examined by polarizing-light microscopy to confirm the presence
and depth of the caries lesions.
Conclusion:• BW radiographs could only identify 26.7% of the lesions which questions its ability to be the
gold standard
• The Canary System is the only method examined with both high sensitivity and high specificity.
• The Canary System is more sensitive than bitewing radiographs in detecting interproximal
caries
Interproximal Caries Detection
Bitewing radiograph did not detect caries.
Caries located on buccal aspect of the contact area
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Demineralized enamel
Caries Detection Method
The Canary System
DIAGNOdent
Sensitivity 83% 64%
Specificity 79% 46%
• Canary Numbers >20 when scanning sealants (3M™ ESPE™ Clinpro™ Sealant) placed over pit & fissure caries.
• The caries detection ability of the Canary System was not affected by sealant & was more accurate than DIAGNOdent.
Sensitivities and specificities for pit & fissure caries detection after sealant placement.
Canary Number 66
Canary Number 37Caries into dentin
Post-sealant
Pre-sealant
Cross-section
Sealant
Detection of Caries Beneath Sealants
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After all the cleaning and diagnostic technology being used, what if you find something?
Topical Therapies• More caries resistant• Remineralization• Desensitization
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Minimally Invasive Treatment
• Apply MIPaste Plus for 3 minutes
• Patient applies at home 2x/day
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MI VARNISH™ WITH RECALDENT™ (CPP-ACP)Bioavailable calcium, phosphate & fluoridefor an enhanced varnish treatment
Bacteria
Produce Acid
Attack Enamel
Demineralization
DECAY
Xylitol & ProBiotics
MI Paste, Enamelon
Remineralize
Other Systems
Radiograph
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Huge Marketing Opportunity• Non Ionizing Diagnostic Tools
• Minimally Invasive Dentistry
• Longer Lasting Restorations
• Community Educational Programs
• Internet and Local Media Advertising
Grow/Change/Eliminate Stories
Your Turn
Questions?
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ABFRACTIONS
Abfraction Lesions
▪ Sometimes it presents as single teeth due to excursive interferences or as a
pivot, fulcrum or “teeter totter” tooth.
▪ Other times there are more in a quadrant and there is severe wear to the
occlusion.
▪ Other times it maybe on the facials of anterior teeth, where there is wear on
the incisal edges or wear facets on the linguals, however little to no wear on
posteriors.
▪ Occlusal guards should be fabricated along with an occlusal analysis in CR on
models.
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Flowables?
Microleakage and missing fillings from high occlusal loads on
teeth can cause large cervical stress concentrations resulting
in disruption of the bonds between the hydroxyapatite crystals
and the eventual loss of cervical enamel and dentin.
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Abfraction Lesions & Class V RestorationsLatin words, ab – “away”, fraction – “breaking”
▪ Pathological loss of tooth structure caused by biomechanical loading forces.
▪ Static and cyclic flexural overloading of tooth structure ultimately leading to
fatigue and failure of tooth structure away from the point of loading.
Resin Modified Glass Ionomers (RMGI)
▪ Light cured
▪ Dual cured
▪ High flexural strength
▪ Lower compressive strength than conventional G.I.
▪ Good polishability
▪ Excellent wear
▪ Hydrophillic
▪ Fluoride release
▪ No microleakage
▪ No adhesives
▪ Acid resistant layer
▪ Reduces sensitivity
▪ True chemical adhesion
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Resin Modified Glass Ionomer Restoration
Post-Op Photo – notice unlike typical class V composite RMGI
restorative material.
Typical treatment involves the placement of a #00 retraction
cord on each tooth followed by a shade selection. Roughen
tooth structure with air abrasion. Place cavity conditioner
on all areas to be restored for 10 seconds, then wash and dry.
Restorative Therapy- Case
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Mix RMGI and syringe into place. Utilize hand instruments to
shape and remove gross excess. Cure each tooth for 20
seconds. Remove excess and contour using a handpiece
with fine diamond burs. Teeth should be isolated from saliva.
Restorative Therapy- Case
After contouring the restorations can be coated with a self
etch adhesive coating, and cure for 10 seconds.
Restorative Therapy- Case
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Six year post-op photos show the integrity of the material is still
excellent. Note the lack of marginal microleakage stain often
present with composite restorations.
Restorative Therapy- Case
Resin Modified Glass Ionomer
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Fig. 15 – Graph representing the mean annual failure rates
per adhesive class, determined according to a systematic
review of Class-V clinical trials of adhesives during the
period 1998–2004 [2].
Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent
Mater (2009), doi:10.1016/j.dental.2009.11.148
Abfraction Lesion Treatments
• Restore defect to protect the exposed dentin
and strengthen cervical tooth structure with
Glass Ionomer.
• Occlusal evaluation from Centric Relation to
Centric Occlusion, with possible occlusal
adjustment.
• Lateral excursive interference evaluation, with
possible occlusal adjustment.
• Check Saliva pH levels for possible erosive
problems.
• Night guard therapy.
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• Bioactive material
• affinity to tooth structure. when placing a glass ionomer a weak acid or conditioner is used to aid in releasing calcium and phosphate ions from the tooth structure. These calcium and phosphate ions combine into the surface layer of the glass ionomer and form an intermediate layer called the interdiffusion zone. This bond layer can be very strong and significantly reduce the microleakage that would occur at the margins of the restoration.
• Very good fluoride and ion release helps remineralize tooth structure in the remineralization–demineralization process that naturally occurs in the oral cavity.
• They bond to enamel, dentin, and metals.
Why Glass Ionomers?
• They produce good marginal integrity.
• They shrink only one ninth the amount of composite material.
• They are fluoride-rechargeable.
• There are no free monomers in the material.
• The cavity preparation can be bulk-filled, making the materials easy to place.
• They exhibit excellent biocompatibility.
Why Glass Ionomers?
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148178/
(RFA-DE-10-004) “Tooth-colored resin restorations have an
average replacement time of 5.7 years due to secondary caries precipitated by bond failure.”
Factors that compromise bond durability in restorative dentistry
We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong
direction
Water sorptionPolymer swelling
Decline in mechanical propertiesLeaching of hydrolyzed resin components
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BOND LOCATION& DEGRADATION
• Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. CompendContin Educ Dent. 2011 Sep;32(7):60-4, 66.
Resin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months.
3x Tubule Density Equals Higher Fluid &
Increased Difficulty for Bonding
%30 Degrease in Bond Strengths with most
bonding systems.
Factors that compromise bond durability in restorative dentistry
Deep Preparations◼ Bonding Agent & Flowable composite
◼ Conventional Glass Ionomer or GI then Composite◼ Fluoride Release
◼ High compressive strength
◼ Hydrophillic
◼ Insoluble
◼ True chemical adhesion
◼ Minimizes microleakage
◼ No sensitivity
◼ Acid Base Resistant Zone
◼ Decreased gap formation & C Factor
◼ Coefficient thermal expansion similar to
dentin
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Drawbacks of Any Composite
▪ Material placement techniques
▪ Polymerization stress & shrinkage
▪ Water absorption
▪ Hydrophobic bonding agents
▪ Decreased bond strength over time
▪ Microleakage
“Adhesive dentistry could be expressed as a
simple relationship between bonds and
stress. If the bonds can withstand the stress,
the restorative technique will be successful.”
Unterbrink and Liebenberg (1999)
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Internal (Polymerization) Stresses of Composites
“A Simple Pain-Free Adhesive Restorative System by Minimal
Reduction & Total-Etching (1993)
Takao Fusayma DDS,
Tokyo Medical & Dental University
“C-Factor” Definition
Configuration Factor:
“The ratio of bonded to un-bonded (free) surfaces”
Feilzer, DeGee, Davidson (1987), Universtiy of Amsterdam, ACTA
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Lowest Stress
Low Stress
Medium Stress
High Stress
Highest Stress
Decreased Bond Strengths
Based on:
▪ Substrate
▪ Preparation technique
▪ Hand piece oils
▪ Bonding agent
▪ Curing device and position
▪ Material Selection
▪ Layering technique
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Flow
or GI?
Composite
Long term failure occurs at gingival margin. (Open sandwich?)
Resin modified glass ionomer
• More conservative
• More enamel
• Microleakage / recurrent decay
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Glass Ionomer Materials
▪ Dentsply-ChemFil Rock Restorative
▪ SDI-Riva LC, Riva SC, self cure HV, light cure HV
▪ G.C. America-Fuji II LC, Equia Fil (Fuji IX)
▪ VOCO-Ionolux, Ionofil Molar AC
▪ 3M/ESPE-Ketac Nano, Photac Fil Quick, Vitremer, Ketac Molar Quick, Ketac Fil Plus
▪ Resin bonding is mostly due to the intertubular dentin.
Deep preparations have less intertubular dentin.
More moisture present due to odontoblastic tissues and fluid
Higher risk of post-op sensitivity
Use a New Advanced Adhesive and Flowable
▪ Glass Ionomer (GI)
True adhesion to tooth structure
Bonds to moist dentin
Less technique sensitive
Fluoride release
Decreased gap formation and cusp deformation
Coefficient of thermal expansion is similar to dentin
▪ No post operative sensitivity
Use on dentin & cementum
Base out deep areas
Place resin/composite on top of GI
Replacing Existing Restorations & Decay
Dentin Bond Strengths of Simplified Adhesives: Effect of Dentin Depth. Compendium June 2006, p.340-345
Using Cavity Liners with Direct Posterior Composite Restorations. Compendium June 2006, p.347-351.
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Glass Ionomer Sandwich
•Class I, II and V posterior restorations
•Open & Closed Sandwich techniques
•Composite replacement
•Amalgam replacement
•High caries risk patients
•Pediatric patients
•Geriatric patients
•Special needs patients
•Long term resistance to microleakage
Composite Leakage
Glass Ionomer Interface
Interfa
ce A
naly
sis (TEM)
CARDOSO et al. J Dent 2010
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V3 Blue Ring by TrioDent
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EQUIA FORTE
EQUIA™ FORTE is a complete system that is an ideal solution for posterior restorations:
•Class I, II, III and V posterior restorations •Composite replacement •Amalgam replacement •High caries risk patients •Pediatric patients •Geriatric patients •Special needs patients •Buildups•Long term provisionals
EQUIA FORTE
Todd Snyder, DDS, AAACD
Caries control/quadrant dentistry(Class II, III, V & core buildup)
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A3.5 A3 A2
Glass Ionomer Bulk Fill
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RESIN TO DENTIN HYBRID ZONE
Minimally Invasive Preparations
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• Open Sandwich with glass ionomer & nanohybrid composite
SDI
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Glass Ionomer Bulk Fill
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Compressive Strengths
▪ GC EquiaFil Compressive Strength 255mpa
▪ Riva SC compressive strength 271mpa
▪ Chemfil Rock Compressive 200mpa
▪ voco Ionolux had higher compressive strength than Equia Fil or Chemfil Rock
▪ Surefil SDR compressive strength 220mpa
▪ dentin 280mpa-297mpa
▪ Enamel 384mpa
▪ Grandio SO HF has compressive 417mpa
▪ Fuji II LC 170mpa (RMGI) Compressive strength
Combination Case-filling
-buildup
-provisional
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GC AMERICA
VOCO
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Glass Ionomer vs. Open Sandwich
Class I or II
:Tooth Preparation
3x Tubule Density Equals Higher Fluid &
Increased Difficulty for Bonding 30% Decrease in
Bond Strengths with most bonding systems.**
What substrate are we treating?
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• 7 years later.
Glass Ionomer vs. Open Sandwich
• 7 years later.
Glass Ionomer vs. Open Sandwich
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Restoration variations
for durable class I & II restorations
2mm
:Composite
:Flowable or Glass
Ionomer
:Bulk Fill Composite
:Glass Ionomer
According to the American Academy of Cosmetic Dentistry 50% of patients are
unhappy with their smiles and 3 out of 5 people will invest in their smiles.
How Do You Get More Cases?
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One of the most powerful & fastest tools you own to create cosmetic opportunities??
WHITENING
Immediate Call to Action Motivator
Start Here
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Over-the-Counter Teeth
Whiteners: $1.4 billion
(MSNBC) ...
(Consumer Reports).
Over The Counter Whitening
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Whitening
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Opalescence GO!• Fast, Easy, Effective, Better
Experience• Convenient & affordable
professional whitening to GO• Pre-loaded, disposable UltraFit™
tray for a custom-like fit• Molar-to-molar coverage• No chair time
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One Shade of Mosaic
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One Shade of Mosaic
Reduce or Eliminate Sensitivity
• Potassium Nitrate & Fluoride
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Opalescence Go Sample Tower
“Total annual revenue in the teeth whitening industry topped $11 billion at the beginning of
2015, with $1.4 billion spent on teeth whitening products. These figures suggest a steady annual increase in the teeth whitening market industry, which is expected to continually climb over the
next 10 years” AACD Research
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So why are people willing to pay top dollar for a beautiful smile
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Cosmetic Alterations
• How many of you want to buy something sight unseen?
• How many of you want to experience something first before investing?
• Your patients are no different!
• They are concerned about how it will look and feel. They want to be excited and happy!
• Don’t Just Tell…..Show & Tell!
Treatment Modalities
Whitening
Bonding
Veneers
Ceramic crowns
Ceramic bridges
Implants
Invisalign/Aligners
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The Key to Success:
VisualizationWhat is the patient’s perception or desired outcome in their mind to create the EMOTION and DESIRE?
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What do they want or envision?
Look at books or your cases.
Bring in examples of smiles.
Everyone has an opinion & priorities
How WHITE?
Translucency?
What Texture?
Color Transitions
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What about example
pictures?
◆ Are they relevant and
realistic?
Overall Feel Motivation
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Why Does this Work?
✓Creates awareness
✓Suggests the possibility
✓Promotes discussion
✓Provides bridge to clinical evaluation and
presentation of options
✓Creates EMOTION and DESIRE
Digital Smile Mockup
-is a proven practice building program that can:
Dramatically increase your patient’s interest in a smile
transformation
Remember, 50% of your patients want to improve their
smile
The goal is to help them visualize themselves with an
improved smile
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When you hand a Digital Simulation to your patient, you plant a seed of what is possible, a constant reminder of what their potential new smile can be. They can show it to their friends and family, you can put a copy in their chart for follow-up, have them hang it on their refrigerator...!
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VIRTUAL SMILES©
• Tooth shape
• Length, width, & style #
• Tooth color
• Translucency, effects
• File Format
• Paper
• CD
• Flash
• Logo & Office Info
• Smile Simulations
You are selling the Emotion…
Do you know “THEIR” desired outcome?
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The Key to Success:
Traditional Veneers
Diagnosis & Treatment Planning
The Key to Success:
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Traditional Veneers
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• Immediate Smile Change Consultation?
• Can they come back in a week?
Time (CONSULTATION)
OR
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U VENEER -- BY ULTRADENT
-Patient wants to fix the small
lateral incisor
-No tooth reduction
OPPORTUNITY
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Beadline Provisional Mockup
Beadline Provisional MockupBeadline Provisional Mockup
Diagnostic Models with a waxup are duplicated. Special over impression is created and used to deliver temporary mockup
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LISTEN For Yourself
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Show & Sell Possibilities..
COSMETICChanges
3 out of 5 • Patient came in to fix small lateral incisors
• Wants “Absolutely” no tooth reduction
• What drives him?• Appearance
• No Tooth Reduction
• Emotion
• Desired Outcome…. Feel Better, more confident?
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Results
Confidence, Dating,Work,Emotional Goals
Cosmetic Dentistry
• Do YOU WANT more Cosmetic Cases?
• Patients desire a change• But don’t know what they want (typically)
• What are their Chief Complaints (pick 3)
• Why?
• And What will that accomplish? Reasoning behind Tx.
• Always look at the big picture
• Take photos
• Write down where they can see their Chief Complaints
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How Do We Create The
Intraoral Mockup?
• First take an impression of teeth with a material that allows you multiple repours.
• Want one original model
• One model for laboratory
• Extra model if you need bleach trays or practice preparations
• Photos
• Facebow
• Horizontal Plane Indicator
• Teeth that are too far facial will remain untouched. When photos are taken they will be less obvious.
MY TWO FAVORITE COSMETIC/EVERYDAY COMPOSITE SYSTEMS
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How Do We Restore?
• Composite, Veneer or Crown?
• Patient Input?
• Color?
How Do We Restore?
• Composite, Veneer or Crown?
• Patient Input?
• Color?
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Initial Mockup
• Select Shade(s)
• Quick Initial Mockup (<3minutes)
– Free Hand
– No adjustments
– Prove Color(s)
– Prove Translucency
– Thickness Role
• Template
– Capture Lingual and Incisal
– Check Template
– Remove Excess
– Remove Composite
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Air Abrasion, Total Etch, Mylar
MPA Max, Template, Evanesce EnamelEVANESCE means to disappear gradually; vanish; fade away
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Evanesce Dentin
Sculpt Dentin, Cure, Add Enamel
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Discs to Contour
Discs to remove fine scratches
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Polishers for surface and interproximal areas
Evanesce Makes the Task Easy
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• nanohybrid
• Superior handling
• High polishability & gloss retention
• Exceptional wear
• Unique syringe design
• Intuitive shade offering
Can you see it? Does the shape look believable? Are the tissues
healthy? Does the texture match?
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Three Shades of Mosaic
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ZIRCONIA CEMENTATION…
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ASAP INDIRECT + POLISHERS
CERAMIC ADJUSTMENT
• Jiffy Ceramic Polishers (Ultradent)
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DIRECT POSTERIOR COMPOSITE
AESTHETICS & OCCLUSION
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•
•
•
•
•
•
•
•
•
•
**
Cement Selection
•
•
•
•
•
•
•
•
•
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Bioactivity by Doxa
A reactive bioactive system that contributes to hydroxyapatite mineralization of hard tissue through ion release and alkaline
pH.**
Cement Selection
Cement Selection
Mix for 8-10 seconds
3-4 restorations
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LITHIUM DISILLICATE (EMAX) OR ZIRCONIA
• Silane is contraindicated
• Tooth etching or conditioning
is not necessary
• Bonding agent is not needed
Cement Selection
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CERAMIR C&B COMPARISON TO OTHER
CEMENT CLASSES
CROWN RETENTION
•
Material Result (Zirconia crowns) Kg/F
Ceramir Crown & Bridge 32.1 ± 6.3
RelyX Unicem (3M) 27.8 ± 11.3
Dyract Cem (Dentsply) 12.2 ± 3.1
Rely X Luting (3M) 10.9 ± 6.5
0
5
10
15
20
25
30
35
Ceramir Crown & Bridge RelyX Unicem (3M) Dyract Cem (Dentsply) Rely X Luting (3M)
Cement Selection
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Cement Selection
Cement Selection
Journal of Esthetic & Restorative Dentistry March 2015
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CROWN RETENTION• Results Zirconia crowns (Kg/F)
Material Result (Zirconia crowns) Kg/F
Ceramir Crown & Bridge 32.1 ± 6.3
RelyX Unicem (3M) 27.8 ± 11.3
Dyract Cem (Dentsply) 12.2 ± 3.1
Rely X Luting (3M) 10.9 ± 6.5
0
5
10
15
20
25
30
35
Ceramir Crown & Bridge RelyX Unicem (3M) Dyract Cem (Dentsply) Rely X Luting (3M)
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• Simplify Cementation
• Silane/Ceramic Primers
are contraindicated
• Tooth etching or
conditioning is not
necessary
• Bonding agent is not
needed
Technique Research/Literature*
• Moisture Tolerant
• No Sensitivity
• Alkaline pH
• Apatite Forming
• Insoluble
• Stronger With Time
• Self Sealing
Clinician’s Choice
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Composite Ninja
Composite Ninja
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Composite Ninja
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Lecture Handout
www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers
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TODD SNYDER(949) 643-6733
www.aestheticdentaldesigns.comwww.drtoddsnyder.com
www.toddsnyderracing.com319
