8 Times Artists Created Works Featuring Teeth

Articles

Smiles feature prominently in plenty of artwork, but sometimes artists go beyond the grin and make teeth the focus of their work in novel ways.

Laura Dorr is the executive editor of DPR's Modern Dental Network.

To etch or not to etch? That is the question—and it’s been around for years. Acid etching on enamel was introduced by Dr Michael Buonocore in the 1950s. Buonocore found that bond retention was improved when enamel was etched with 85% phosphoric acid, and the technique has been hailed as the advent of bonding to tooth structure.

While 85% phosphoric acid is seen as overkill today (it’s best to stick to 35% to 40% concentrations), acid etching is still used to increase retention and bond strength of resin-based adhesives.

Over the years, etching has expanded to include not only enamel, but also dentin, which prompted the introduction of alternative etching techniques that didn’t use phosphoric acid.

Etching demineralizes portions of the hydroxyapatite crystals found in enamel and dentin to create a porous surface that allows the formation of resin tags in the dentin’s structure. Essentially, an etched surface has pores that allow the resin to permeate and attach to the tooth.

But etching techniques vary depending on the shape and size of the prep and whether you’re trying to bond to dentin or enamel. Even within those categories, there are 3 approaches to consider: total-etch, selective-etch, and self-etch. But which is the best technique? It depends.

Etching techniques are dependent on the surface that is being etched, as enamel and dentin respond differently to etching.

Enamel is highly inorganic, while dentin is a more hydrated tissue made up of 20% water and 30% collagen. Composed of approximately 92% inorganic hydroxyapatite, enamel’s structure and crystal arrangement are much more regular than dentin’s structure. This makes enamel etching and bonding significantly easier and more predictable—simply isolate, apply acid etchant for 10 to 15 seconds, rinse, and bond.

Dentin is only approximately 50% inorganic and contains fluid-filled tubules. Since dentin is hydrated, it can make bonding difficult, as bonding is inherently hydrophobic. Additionally, dentin’s composition and permeability vary by region and depth of the tooth, making it less uniform than enamel. Etching on dentin can be tricky, and the results can be more unpredictable than enamel etching. Many practitioners hesitate to etch on dentin at all.

“Less-retentive preps benefit most from etching, although it is much harder to etch dentin, which is normally what there is most of in a compromised crown prep,” says John Flucke, DDS, 

®’s technology editor, who practices in Lee’s Summit, Missouri. “The bond strength to enamel is much stronger than to dentin.”

Dentin bonding can be achieved through self-, selective-, or total-etch techniques. While self-etch systems have lower bond strengths, which can be problematic in less-retentive preps, they also generally result in lower rates of postop sensitivity. This can be a serious problem when etching on dentin, particularly when over-etched.

In addition to causing postop sensitivity, over-etching can also be a culprit in bond failure, because if the demineralization penetrates farther into the tubules than the resin can travel, it can result in a gap.

In total-etch procedures, acid etching is performed on the surfaces of both the enamel and dentin layers. This classic technique applies 30% to 40% phosphoric acid to the entire preparation, which removes the smear layer on dentin, opens the underlying dentin tubules, and exposes the collagen fibers, which are infiltrated by a hydrophilic resin monomer to create a bond—all while also creating a suitable etch pattern on enamel. The phosphoric-acid application is followed by a rinse and subsequent application of primer and bonding agent.

Total-etch procedure presents the highest likelihood of postop sensitivity if not executed correctly. Because all of the dentinal canals are opened during total-etch, there is a risk that restorative materials may irritate the pulp if the canals are not closed appropriately by the bonding material. This is a real concern, as technique variability is high in this approach. There is a delicate balance to ensure that the enamel is etched properly without over-etching the dentin. Residual moisture after rinsing dentin and the amount of time it takes to etch the dentin also can be detrimental to the bond.

In scenarios where the working surface includes both enamel and dentin, selective-etch (or hybrid-etch) technique gives clinicians the ability to apply phosphoric acid only to the enamel area and use a self-etch adhesive on the dentin.

“I personally believe in a selective-etch approach using a universal bonding agent,” says, Rolando Nuñez, DDS, manager of clinical research at BISCO. “Literature has shown that etching enamel with phosphoric acid is of the essence to achieve a predictable and strong bond.”

By providing a deep etch on the enamel, this technique optimizes enamel bond strength, while removing the risk of over-drying or over-etching the dentin, which can lead to postoperative sensitivity. This approach can be particularly advantageous when working with deep areas in the tooth where acid is at increased risk of causing sensitivity.

While selective-etching may take a few more steps than other etching techniques, treating each surface individually can create a stronger bond. However, precision is required: Practitioners must ensure that no etchant reaches the dentin, as it can compromise bond strength.

Self-etching has grown in popularity, as it eliminates some of the risks of total-etch systems (such as over-etching that can lead to postop sensitivity) and performs well for dentin bonding.

By using acidic monomers instead of phosphoric acid to demineralize the tooth structure and remove the smear layer, self-etch bonding systems can reduce the risk of bond degradation caused by matrix metalloproteinase, as well as the aforementioned sensitivity. Self-etch eliminated the need for etching and rinsing required by total-etch, and it also prevents the collapse of the collagen fibers, which can be a problem with the total-etch process due to conditioning and drying.

“Self-etch has proven to work very well on dentin,” Dr Nuñez says. “This approach will yield high bond strength and protect the pulp at the same time. There is no true need to etch dentin with phosphoric acid.”

Self-etch can also be simpler than total- or selective-etch techniques. In addition to not having to worry about over-etching or overdrying dentin, practitioners don’t have to worry about the timing of acid exposure on enamel versus dentin.

“Sometimes I think doctors will first try a self-etching cement because there are fewer steps to its use and controlling the field is easier,” Dr Flucke says. “Proper control of the field is critical to adhesive dentistry, and it’s always much more challenging to try to control the field on a lower second molar with a patient [who] has a very high salivary flow. In cases such as these, it may help to use some adjunct evacuation system such as Isolite (Zyris), Mr. Thirsty (Zirc), or DryShield to help control the situation.”

However, because self-etch systems aren’t as strong as acid etch approaches, bond strengths can often be lower.

In the end, there is a time and place for total-, selective- and self-etch approaches when it comes to preparing enamel and dentin for restorations. Clinicians should consider which approach will create the strongest bond with the lowest risk for postop sensitivity—and ultimately, the greatest chance of restoration success.

Breaking down indications for etching and how to choose the best approach.

Etching techniques unpacked

Sherree Geyer is a freelance healthcare/medical writer who specializes in making complex, technical information easy to reach. She writes frequently about opioids and other pain management techniques for “Pain Medicine News” as well as immunology for special publications produced by McMahon Publishing. She also writes about cancer for “Everyday Health” and migraines for “HeadWise,” published by the National Headache Foundation. 

Other publications for which she’s written include “Rural Health Quarterly,” “Hospitals and Health Networks,” “MD+DI,” “Managed Healthcare Executive,” “Health Systems Management,” “NurseZone” and others. As the first communications manager for the American Association of Critical-Care Nurses, she developed the association’s editorial style and award-winning member magazine, “AACN Bold Voices,” which she edited. She also served as editor for an e-newsletter, “Critical Care News,” and trade show daily, “NTI News.

Most dentists experience long-term disability from musculoskeletal disorders, with as many as 81% suffering from back, neck, shoulder, or arm pain, according to disability attorneys at Comitz | Beethe in Scottsdale, Arizona. Citing income plan data from the American Dental Association (ADA), the firm’s 

 that musculoskeletal disorders of the spine, shoulder, and wrist comprise 37% of dentist-related disability claims. “In 2009, nearly one-half of open claims, paid to disabled dentists under the ADA Income Plan, were for back and cervical disorders, arthritis, and wrist issues,” according to the firm’s website.

, an insurance program manager for health care professionals in Salt Lake City, Utah, confirms this data. “Dentists become disabled more often than the rest of the population because their work involves using their hands, standing, and bending. As a person who works in an office all day, if I hurt my back or hand, I can still do my job. [If I were] a dentist, I probably [couldn’t],” Brunken says. He calls disability insurance a hedge against income loss from injury or illness.

“A health care professional’s income is tied to their ability to perform their medical, or in this case dental, specialty,” he says. “The procedures they’ve built into their practice have unique income protection needs. A good disability policy will pay benefits if a dentist can’t perform the duties that earn them money.”

While life insurance may get a lot of attention, the risk of becoming disabled exceeds that of dying on the job, adds Rick Gundling, FHFMA, CMA, a senior vice president at Healthcare Financial Management Association in Westchester, Illinois. Dentists should assess their complete financial picture to determine the type of insurance that’s right for them and their solo or group practice, he advises.

“Do I have enough of an emergency fund? What does my retirement fund look like? Could I work if I got disabled? What happens if I have a large mortgage and small children? Short-term disability kicks in after 3 months,” Gundling says. “If you’re out of work for 2 months, that might be fine. Have I saved up 3 months of living expenses? If I haven’t, I might want to take out individual disability insurance (IDI) to supplement that.”

Policies should cover 60% to 70% of practice earnings, according to Brunken. “I see a lot of dentists with $5000 to $7000 of IDI coverage, which is really good. The problem is that it only replaces 35% to 40% of the average dentist's income. If that income gap persists, it’s hard to maintain a pre-disability lifestyle,” he says.

Employer-based group policies may provide benefits of up to 50% of living expenses, he adds. “[But] the policy ends with the employment or practice,” he says. Brunken suggests purchasing supplemental policies to cover 20% to 30% of the remaining lost income.

Dentists should look for true own- or transitive-own occupation policies that pay benefits upon total occupational disability. If a policyholder becomes employed in another profession, these policies provide monthly earnings as long as they don’t match or exceed earnings from the previous occupation.

Mental/nervous and substance abuse (MNSA) riders pay benefits per occurrence, not per lifetime. Per-occurrence policies cover substance-abuse relapses, usually at 6 months between events. But 24-month lifetime policies don’t cover relapse as a disability.

Policies that cover all income sources, including bonuses and earnings, and index to the rate of inflation. The ADA describes automatic cost-of-living adjustments as “particularly beneficial for long-term disabilities that extend for several years or even decades.”

Business overhead expense (BOE) insurance that covers operating costs of practices. The ADA offers overhead insurance that pays up to $25,000 a month against operational practice costs. This can include staff payroll, monthly rent or mortgage, utility, and phone bills, replacement dentists as needed, life and medical insurance premiums for staff, practice and student loan payments, property and liability insurance premiums, and professional association dues.

“In a smaller practice setting, if a key partner can no longer pay their share of business expenses, the practice can get into trouble quickly. That’s why BOE insurance is critical. It works [as] a disability policy. If one becomes disabled, they can start receiving BOE benefits to pay their business expenses,” Brunken explains.

“In the age of COVID-19, dentists and other practice owners are under a lot of pressure to keep their practices going. Dentists need to get coverage to protect [themselves] if they develop disability related to mental or nervous issues,” Brunken says.

Gundling speculates COVID-19 spurred interest in IDI. “What would happen to me if I got the virus? People think of their own fragility. You and I might think more about germs on that shopping cart handle. If you’ve visited a friend in the hospital or had a parent in a nursing home, it makes you more cognizant,” he says.

“Dentists need to find coverage to protect the practice staff while giving them protection to safeguard their income,” Brunken says. “There are business and altruistic reasons for dentists to offer a group long-term disability program for staff. Dental practice employees need protection. The odds of becoming disabled are high, and the economic effects can be devastating. IDI carriers are unlikely to write [an individual] policy for a staff member. If not through a group policy, where would they get protection?”

According to Brunken, “The business reason for offering group disability benefits is the same as [offering] other benefits. You need to recruit and retain the best people. If you’re not offering this benefit, you’re not as attractive.”

Disability insurance can be bundled into a benefits package for employed dentists, Gundling says, adding that younger employees might expect enhanced benefits, such as maternity leave, more now than they did 40 years ago.

1. Musculoskeletal conditions in dentistry: the most common disability, the most difficult disability claim. Comitz | Beethe. Accessed November 1, 2020. 

https://www.disabilitycounsel.net/firm/dentist-resources/musculoskeletal-conditions-in-dentistry/

2. Disability income protection insurance plan. American Dental Association. Accessed November 1, 2020. 

https://insurance.ada.org/ada-insurance-plans/disability-insurance.aspx

3. Office overhead expense plan. American Dental Association. Accessed November 1, 2020. 

https://www.insurance.ada.org/ada-insurance-plans/office-overhead.aspx

Over 80% of dentists experience musculoskeletal conditions related to practicing dentistry. Having disability coverage can be crucial to protecting yourself and your practice. 

Insurance coverage can help dentists survive disability, pandemic

New analysis from the Emergency Care Research Institute (ECRI), one of the country’s top patient safety organizations, has shown that more than 50% of disposable isolation gowns it tested failed to meet regulatory standards, according to a statement from the non-profit organization. This puts healthcare workers at risk of exposure to pathogens, including the SARS-CoV-2 virus.

52% of gowns with unstated levels of protection failed to meet the Association of the Advancement of Medical Instrumentation’s (AAMI) lowest level of protection, according to researchers at ECRI. These researchers tested gowns that claimed to have AAM-level protection but found that 50% did not meet the AAMI PB70 standard, a system for the evaluation and classification of liquid barrier performance.

The effectiveness of 34 models of disposable gowns from suppliers outside of the United States or from non-traditional suppliers has come into question after being evaluated by the ECRI. This assessment was conducted by ECRI’s quality assurance experts at the organization’s independent medical device laboratory according to the strictest product testing protocols, according to a statement from ECRI.

“[Healthcare facilities] have been ramping up their procurement of isolation gowns to protect workers from the novel coronavirus and we’re finding that many of the products they are buying simply do not meet basic protection standards,” said Marcus Schabacker, MD, PhD, ECRI’s president and chief executive officer. “Our research shows that you can’t judge the authenticity of the product based on its appearance, labeling, or packaging without product testing.”

Since the beginning of the SARS-CoV-2 pandemic, a lack of personal protective equipment (PPE) put the health care industry in a precarious position, forcing many providers to use alternative supply sources. Much of the PPE from international or non-traditional supplies are unsafe and ineffective, according to the ECRI. The organization released its report of imported masks in September, which found 70% of the Chinese KN95 respiratory masks failed to meet U.S. safety standards.

ECRI experts warn against the use of isolation gowns from outside of the United States or from non-traditional suppliers. If these products must be used because there are no other viable PPE options, they should only be used in extremely low-risk situations or undergo independent laboratory testing for liquid impact and hydrostatic penetration to verify barrier protection.

“As we have seen first-hand, manufacturer test reports or certificates are not a guarantee that these gowns are safe and effective,” said Michael Argentieri, vice president for technology and safety at ECRI. “We are advising our members against purchasing gowns that do not adequately protect healthcare workers, especially during the pandemic.”

Read ECRI’s full alert to healthcare providers 

. For more information on the organization’s independent testing guidelines, email 

The non-profit organization conducted testing on 34 models of gowns from international or non-traditional suppliers. 

ECRI finds more than half of disposable gowns fail safety standards

In the back and forth patent infringement case between 3Shape and Align Technology, a final ruling this week from the U.S. International Trade Commission (ITC) states that 3Shape has not infringed any valid Align patents. Shortly after the ITC ruling, both sides issued press releases and not surprisingly, offer differing views of the ruling.

On Wednesday, 3Shape announced that the company has received a favorable final ruling from the ITC in the third patent infringement complaint Align Technology has filed at the ITC against 3Shape since November 2017. Two days earlier, the ITC had issued a final decision regarding Administrative Law Judge (ALJ) MaryJoan McNamara’s opinion in Investigation No. 1144 from April 30, 2020.

In this final ruling, the ITC found that 3Shape has not infringed any valid Align patents, and thus, 3Shape has not committed any unfair acts as alleged by Align. According to 3Shape, this marks the third time the ITC has provided a favorable outcome for the company, which develops 3D scanners and CAD/CAM software solutions for the dental industry.

Last November, the ITC affirmed ALJ Cheney’s initial determination finding 3Shape had not committed any unfair act and terminated in its entirety Investigation No. 1091. Prior to that, ALJ Dee Lord also ruled in 3Shape’s favor in Investigation No. 1090, finding that 3Shape did not infringe any valid Align patents.

In a press release on Wednesday, Align announced that it was not in agreement with the lastest ruling from the ITC.

"We respectfully disagree with the Commission’s reversal of the Administrative Law Judge’s determination and are evaluating our next steps in this matter, including possible reconsideration by the full Commission and/or an appeal to the Federal Circuit,” Julie Coletti, Align Technology senior vice president, chief legal and regulatory officer, says in the press release. “We remain steadfast in our commitment to protecting our patented inventions and are proud of our history of innovation, our over two billion dollars in investments in technology and the benefit that our innovations bring to patients and doctors. The ITC is a venue where domestic industry seeks exclusion orders prohibiting importation of infringing goods. We have also asserted more than 25 patents across 6 U.S. District Court cases, where we are seeking damages and injunctive relief for 3Shape’s infringement.”

“We are pleased that the Commission has found no violation by 3Shape. Following 3Shape’s favorable outcomes in all three ITC Investigations Align initiated, this is yet another victory for 3Shape, innovation, and dental professionals,” says

Jakob Just-Bomholt, CEO of 3Shape, says the company is pleased that the Commission did not find any violations by 3Shape. He a statement released by 3Shape, he says: “Align has attempted to use ITC investigations to block 3Shape’s innovative products in the intraoral scanner market and has now completely failed in its attempt.”

In addition to defending against Align’s infringement claims in the ITC and the District Court of Delaware, 3Shape has filed its own patent infringement claims against Align in the District Court of Delaware to address Align’s infringement of a number of 3Shape patents, 24 petitions for IPRs with the United States Patent and Trademark Office (USPTO) to address the invalidity of a number of Align patents, and an antitrust lawsuit in the District Court of Delaware to address Align’s abuse of monopoly power.

The initial determination of the Administrative Law Judge (ALJ) had found 3Shape infringed two of Align’s patents and found a violation of Section 337 of the Tariff Act of 1930. The ALJ recommended an exclusion order and cease and desist order be entered against 3Shape’s unlawful importation, but this ruling came prior to this week’s announced reversal.

The Commission now has found that there was no violation of Section 337. The Commission found that 3Shape had infringed certain Align patent claims, but found those claims invalid. The Commission further did not disturb the ALJ’s findings that two other Align patents were valid, but reversed the ALJ’s finding that 3Shape had indirectly infringed those patents.

Align Technology’s iTero intraoral scanners are designed to deliver speed, reliability, intuitive operations, and optimal visualization capabilities for general practitioners or orthodontists. The company is a leading provider of clear aligner solutions with the Invisalign system.

In its final ruling, the U.S. International Trade Commission finds that 3Shape has not infringed any valid Align patents, and thus, 3Shape has not committed any unfair acts as alleged by Align. 

ITC Issues Final Decision on Patent Infringement Case Involving 3Shape and Align Technology

We all like having options. But too many options can be detrimental. Imagine standing in front of the ice cream cooler in the grocery store and choosing from 100 flavors. While the variety is impressive and surely provides the perfect selection for everyone, you’re stuck trying to decide—or end up leaving with a dozen different flavors. Being presented with fewer options makes the decision a lot simpler, and you’ll most likely still walk away satisfied.

The same goes for dental cements. Providing yourself with a variety of choices is critical for restoration success, but there’s no need to stock hundreds of cement systems. Keeping numerous systems in-house increases inventory costs and the likelihood that the cements will expire before you need to use them.

So, how do you know which cements to stock? While there isn’t a 1-size-fits-all cement for every indication, there are several important considerations to help you figure out how many cements you need while also reducing your inventory to a manageable amount.

There are myriad indications to take into account when choosing a cement system.

“When bonding cosmetic cases, we have 1 system,” explains John Flucke, DDS, 

®’s technology editor, who practices in Lee’s Summit, Missouri. “We have another for cementing implant crowns, etc. And different indications also affect cement choice. For example, in addition to restoration material and location of the restoration, the available retentive properties of the prep, prep sensitivity, and cosmetics all come into play.”

The restoration’s location can help you determine which cement to use. Anterior restorations will require a cement with higher esthetic properties. While esthetics aren’t as critical to posterior cases, these hard-to-reach cases may require a cement that is more moisture tolerant, since isolation will be a larger challenge. This means turning to a conventional cement that can accept some moisture.

For example, glass ionomer cements are extremely tolerant to moisture, and resin-modified glass ionomer (RGMI) cements are ideal for situations where maintaining a dry operating field may be difficult or impossible. Conversely, total-etch resin cements require precise isolation from contamination, and they should be avoided in cases where maintaining isolation is difficult.

Cementing will be a waste of time if the cement can’t bond with the substrate in indirect restorations. It’s critical to choose a cement that is compatible with the restoration material. Resin cements are an ideal choice for glass-ceramic restorations, thanks to their superior bond strength. RGMI cements are indicated for metallic, PFM, lithium-disilicate CAD/CAM inlays and onlays, and also for alumina- and zirconia-based ceramics. This all comes back to the golden rule of following the instructions: By reviewing manufacturers’ guidelines and recommendations for use, you can ensure you’re stocking a product that will work with a designated restoration material.

Just because a cement can bond to a material doesn’t mean it’s the only choice. Esthetics play a major role in cement selection, as varying opacity and even viscosity can affect the end result. In general, light-cured cements provide better color stability (necessary to mimic the color of natural dentition) and are available in a wide range of VITA and chromatic shades.

For example, say you’re doing a thin-walled restoration, such as a veneer. You’ll want to reach for a low-viscosity material to ensure the restoration will seat easily and postseating drifting will be minimized. Thanks to their thin film thickness and high translucency, this makes resin cements an optimal choice—provided they are light-cure and total-etch. While self-adhesive cements may be simpler to use, they should be avoided for this type of restoration as they are prone to color change over time, which can adversely affect the appearance of the veneer over time.

Not every case will present with easy prep. In situations where prep may be compromised, cement strength becomes paramount. Retentive crown or bridge preps don’t require extra bond strength, so a conventional cement, such as a glass ionomer or RGMI cement, can be used (though self-adhesive resin cements can be considered in cases where the restoration material (such as glass ionomer) is weaker.

Self-adhesive resin cements should also be the choice for nonretentive preps, or preps with a smaller surface area. The strong bond strength of resin cements can help give extra support to the restoration, and their esthetic properties make them adaptable for both anterior and posterior restorations. These cements are also ideal for partial preps (particularly on enamel), though generally indicated for use with a separate bonding system and enamel etch.

Choosing the correct cement will be a moot point if it can’t be properly dispensed easily, or has a narrow window for removing excess cement. Additionally, introducing extra steps such as mixing into the process greatens the likelihood of user error. “I prefer systems that are self-mixing, because I know that when it exits the dispenser it will be mixed exactly according to the manufacturer’s specifications,” Flucke says.

Using self-mixing, all-in-1 universal systems is an efficient way to cut down on the cumbersome steps that increase opportunities for mistakes. Since universal 1-bottle systems combine the etching, priming and bonding steps into 1, it eliminates the need for mixing, while also reducing the need to use multiple products for 1 procedure. Additionally, the range of protocols they allow for (self-etch to total-etch, light-, dual- or self-cure composites) mean that dentists can implement their preferred methods.

So, what’s the right number of cements to stock? Dentists are going to need at least 2—a resin cement and a conventional cement. This gives practitioners flexibility for situations where moisture may be an issue, or where esthetics is paramount.

“We currently keep 4 different systems in my practice,” he says. “Which one we use depends on the case.”

By stocking 4 unique systems, Flucke can cover a range of needs. In his practice he always makes sure to have Maxcem Elite Chroma (Kerr), PermaShade LC (Ultradent Products), TheraCem (BISCO) and Variolink (Ivoclar Vivadent) on hand.

Each system brings different strengths to the table for different indications. Maxcem Elite Chroma has an automix delivery system, and its Color Cleanup Indicator makes cement cleanup easy. PermaShade LC, designed for use with porcelain, composite and zirconia veneers, has excellent color stability. Variolink is ideal for glass-ceramic, lithium disilicate glass-ceramic, and composite restorations. Universal adhesive TheraCem, which contains methacryloyloxydecyl dihydrogen phosphate (MDP) to promote a strong bond to zirconia, metal, and alumina substrates without a primer, has the added bonus of releasing calcium and fluoride. 

While some clinicians may find they need a wider variety to cover a range of indications, there’s no need to stock a cement for every imaginable scenario. By limiting your selection—while still making sure you’ve covered your bases—you can cut down on inventory costs but still provide superb, long-lasting cementation.

Here’s how to decide which cements to stock and what to keep in mind when choosing systems. 

Review Your Cement Inventory to Increase Flexibility, Decrease Costs

Videos

Managing editor Stan Goff is joined by Bankers Healthcare Group chief marketing officer Chris Panebianco to discuss how dental practices are dealing with the financial challenges they've faced due to the coronavirus disease 2019 pandemic.

Dental Practice Finances During the COVID-19 Pandemic: A conversation with Bankers Healthcare Group chief marketing officer Chris Panebianco

South Korean digital dentistry provider Medit has announced an update to its Medit Link software with the release of patient communication applications. The new free applications focus on patient communication, providing visualizations of potential results to help the patient understand their options and achieve their ideal smile.

Medit Ortho Simulation, Medit Crown Fit, Medit Smile Design, and Medit Compare expand the realm of what a scanner can do


The four applications are designed to aid patient understanding, covering a wide range of uses. Medit Ortho Simulation can demonstrate multiple potential tooth movement scenarios to help the patient visualize a future smile. Medit Crown Fit helps the clinician see possible pressure points designed to enable a modeless workflow reducing chair time and increasing patient comfort.

Medit Smile Design takes the patients future smile and places it in their image, so they can see what digital dentistry can do for them, while Medit Compare automatically aligns two sets of scan data, allowing for comparison.

Medit Link 2.3 makes scanning easier than ever


The new update allows the user to ignore selected colors, such as the color of one’s gloves. The exact colors to be ignored can be chosen using the scanner. This reduces the number of artifacts introduced by a clinicians’ gloves during retraction, shortening the time needed to conduct a scan.


Unlike a closed system, an open system such as Medit enables dentists to take advantage of any developments and improvements in software, according to Medit CEO GB Ko. He adds that Medit has worked to ensure that the most recent advancements are available to all intraoral scanner users, allowing them to increase their productivity.

New free applications provide visualizations of potential results to help patients understand their options and achieve their ideal smile.

Medit Link Software Update Features Patient Communications Applications

As a part of its continued efforts to support dental practices during a challenging 2020, Bankers Healthcare Group (BHG) recently announced it has extended the terms of its business loans from 10 years to 12 years to allow borrowers greater flexibility and lower monthly payments.

BHG provides these loans at amounts up to $250,000 with approval within 24 hours and funding available in as little as 3 days, according to a press release. The loans can be used to consolidate debt, finance new practice investments, purchase or start a practice, improve cash flow, or other to meet other financial needs of a dental or medical practice. 

In addition to extending loan terms, BHG also has expanded weekday hours, added weekend hours, and actively provided loans throughout the coronavirus disease 2019 pandemic.

As a response to the ongoing challenges dental practices face during the coronavirus disease 2019 pandemic, BHG is making loans available on 12 year terms.

Bankers Healthcare Group Extends Business Loan Terms

Available in both discs and blocks, Structur CAD from VOCO, is a new strong and esthetic composite material for milling long-term temporary crowns and bridges.

Restorations fabricated from the material can serve for up to 3 years. The material is said to offer a high degree of edge stability after milling. It does not require firing nor glazing and can be polished quickly to provide natural looking fluorescence and esthetics. The temporary restorations fabricated with Structur CAD can be customized and repaired using conventional dental composites.

The material can be cemented using either temporary cement or a longer-lasting dental adhesive, and it does not require an MMA primer.  Available in shades A1, A2, and A3, Structur CAD can be purchased in size 40L blocks or 20 mm discs.

Long-term temporary material can be used for restorations that can last up to 3 years.

Structur CAD is VOCO's Newest CAD/CAM Material for Long-Term Temporaries

Carestream Dental has announced that the latest version of CS Model+ v5, with its advanced algorithms and artificial intelligence (AI), now helps dental practices meet patient demands and respond to industry trends with the ability to design affordable clear aligners right in the office.

This update is designed to make CS Model+ v5 even more intuitive with the addition of new features such as “degree of difficulty” case ranking; automatically generated intermediate treatment steps; IPR suggestions; and a library of attachments. It not only empowers more clinicians to offer chairside aligners, but it does so when it’s most convenient to both the clinician and the patient,

For more straightforward treatment planning decisions, the new update uses AI to rank a case’s degree of difficulty. The case complexity index is an exclusive feature to CS Model+ v5 that guides doctors through the level of difficulty of the case with an easy-to-understand color code system, from green (simple and straight forward) to red (outside the clinically proven capabilities of aligners). For teeth that are indicated as more difficult, doctors can always take a deeper dive and obtain more details about the case situation for greater insight.

Since patients don’t always understand why they wouldn’t be a good candidate for aligners, the color-coded teeth on the virtual model are designed to make it easier for clinicians to explain why more conventional methods might be necessary. If the patient is a good candidate, CS Model+ lets the clinician play a video that shows their treatment progressing through the steps—a great tool for patient communication, helping them fully understand their treatment journey.

This latest version of CS Model+ features the ability to automate much of the case, reducing manual input from the clinician. For example, if interproximal reduction (IPR) below 0.2mm per side is indicated at the beginning of treatment, the software automatically manages the first step. If the amount of space needed exceeds 0.2mm per side, or if the clinician prefers to perform interproximal reduction later, the IPR table can be modified and the steps will automatically be regenerated, according to Carestream Dental.

The software also automatically generates intermediate treatment steps based on clinician-indicated constraints, so there’s no need to manually create each individual step. From there, an editable gallery lets clinicians preview models and the complexity of each step, so they have absolute clarity and confidence about the case.

Should attachments be needed for a clear aligner case, CS Model+ v5 provides a library of attachments with different options for rotation, extrusion-intrusion, torque or even combined movements. A single click on a tooth and the attachment is automatically placed in the center and can be moved or modified as needed. While automation is a key part of the update, clinicians remain in full control and can place or remove attachments at any stage of the treatment process.

Once the case is ready, doctors can choose to have designs sent to a lab or, for an even more complete end-to-end workflow, print in-house with any third-party FDA approved 3D printer. To simplify printer selection, 3D Systems, SprintRay, RapidShape and Formlabs are all validated for use with CS Model+ to fabricate aligners in-house.

CS Model+ v5 is part of Carestream Dental’s CAD/CAM portfolio, CS Solutions, which lets practices combine the solutions—from intraoral scanners to extraoral imaging systems to software—that work best for their practice and patients. In-house aligners are an affordable solution that keep the clinician in complete control over the case. The speed at which they can be delivered and the personalized touch the clinician can add by keeping patients in-house lets them easily compete with big name brands.

To learn more about CS Model+ v5, CS Solutions or any of Carestream Dental’s innovative solutions, visit 

Using advanced algorithms and artificial intelligence (AI), the new update now helps dental practices meet patient demands for clear aligners and respond to industry trends. 

Carestream Dental’s Latest Version of CS Model+ v5 Designed to Make In-House Aligners More Accessible

Bellus3D recently won a new U.S. patent covering its automatic process for aligning multiple 3D face models of a patient with dental intraoral scans without the need for external markers.

This technique is used to create fully aligned 3D models of patients which can be used for both dental treatment planning as well as clinical diagnostics. The patented workflow begins with intraoral 3D scans of the patient's upper and lower jaws. Next, a 3D extraoral face scan is completed and the software aligns and integrates the images.

Prior to this new software solution, markings were used to provide common reference points for the images. The updated software accomplishes the same thing using the patient's exposed teeth while smiling to create these reference points. Finally, a second face scan showing the patient with a resting facial expression can be aligned as well.

Newly patented software application makes creating digital full face models of patients simpler.

Bellus3D Wins Patent for Automatic Alignment of Digital Face Scans

Lisa Newburger, a master's level social worker supervisor, helps audiences find humor in talking about tough topics. Her "in-your-face" style of presentations and writing will make you smile or just shock you into taking some action. Either way, she is very effective at empowering others to reach their goals and feel better about themselves. Her entertaining workshops are available for national and international audiences. Writing for the dental industry since 2010, she uses an alterego (Diana Directive) to illustrate her points in a sarcastic but effective way. Presentations can be scheduled by contacting Lisa at www.discussdirectives.com/dental.html.

It is slowly creeping upward. You know what I am talking about…your weight. When will it stop? Your clothing fits a little more snugly. Ok, a lot more snugly. I know this is not a critical topic for a dental professional, but it is important. Your health matters. The coronavirus disease 2019 (COVID-19) pandemic is causing more health problems than you may realize. It is time to look at weight gain and compulsive overeating as bigger challenges. Are you coping with stress by overeating?

The gyms were closed for a while. I have not gone back. I miss using the exercise machines, but I do not feel it is safe. An environment that has sweat flying and people breathing hard makes me think it is a petri dish for the virus to thrive in. So, I pivoted, looked at what I could do, and turned to the internet. What an incredible resource for any type of exercise you can imagine! And many of the exercise videos found online are free to view.

I shifted to hiking. Do not get me wrong, I was never an outdoors kind of girl. (I don’t like the cold or the heat.) My husband is a member of a ski club, a mountain bike club, and a cycling club. And he does his bench aerobics live-streamed. Give me dancing, Zumba, my elliptical machine, and speed walking. I now enjoy nature more because hiking is something we do together.

Then there is all the time we spend in the house, working, playing, and hibernating. Our movement has slowed down quite a bit. I miss getting in my car and going places, seeing things, meeting people. I miss concerts, outdoor festivals, volunteering; the list goes on and on. I don’t know about you, but I don’t remember being bored before the pandemic. There was never time for that. Now I wonder how often boredom is making me head for the kitchen. It’s something to do. I know I am not hungry, yet there I am opening the door, looking for something to excite me. Let’s face it, this is a struggle many of us are dealing with right now.

People are cooking more. Going to the grocery store becomes the high point of our week because there are so many people to look at. Are we buying food to cheer us up? Or is it giving us something to do, cooking?

We are facing a crisis. Nearly 40% of adult Americans are obese.

 This is putting us more at risk for cardiovascular disease and diabetes. Obesity is a major risk factor for catching COVID-19. We need to look at this from the perspective of what can be done to stay healthy.

Have you gained weight during the pandemic? Are you comfortable with the weight gain? Is it time to act so that the scale does not climb higher?

My objective is to draw your attention to this issue with a call to action. Track what you eat for a week as well as how much you exercise. If you are happy with the results, then that is that. But if you want to make changes, make a plan. Go on a walk once a week. Then go more than once. The key is to do something—anything—different from what you were doing. After all, this is the first step to take some control of your life during a time when it may seem out of control.

 and let me know your thoughts on weight challenges during a pandemic.

1. Obesity Facts in America. Healthline.com. 

https://www.healthline.com/health/obesity-facts#1.-More-than-one-third-of-adults-in-the-United-States-are-obese

. Published 2017. Accessed November 1, 2020.

Maintaining a healthy weight is important, even in the midst of a pandemic.

Gaining weight during a pandemic

Managing editor Stan Goff talks with Andrew Matta, DMD, about how North American Dental Group navigated the coronavirus disease 2019 pandemic and what Dr Matta sees ahead for the dental industry in 2021 and beyond the pandemic. 

How a Group Dental Practice is Navigating the COVID-19 Pandemic: A conversation with Andrew Matta, DMD, MBA, co-founder and chief medical officer for North American Dental Group

Dental Services Group® (DSG), one of the country’s largest networks of dental labs and dental lab services, has announced the launch of its new podcast, “DSG Connect”. The goal is to connect dental professionals with industry leaders, innovators, and trendsetters to offer unique weekly content.

"DSG is committed to serving and enriching dental practices through exceptional customer experiences including outstanding service and support,” said Lou Azzara, CEO of DSG. “The DSG Connect podcast will provide valuable educational, practical, and inspirational content to connect dental practices nationwide virtually with today’s thought leaders on relevant and emergent dental industry topics.”

Podcasting will give the company an additional platform to provide educational and inspirational content to help elevate dental practices nationwide, a statement from DSG read. The “DSG Connect” podcast is available on Apple Podcasts, Spotify, and at 

The new podcast is available on Apple Podcasts and Spotify.

Dental Services Group introduces new podcast

On this episode of the ProdPod, DPR Associate Editor Kristin Hohman speaks to Dr. Michael Snider of Cambridge Dental Associates in Greenwood, SC. Dr. Snider discusses the COVID-19 pandemic and how his practice has actually seen an increase in business since reopening. He also talks about how restorative materials can be efficient while reducing costs.

https://www.dentalproductsreport.com/view/prodpod-episode-25-the-business-of-procurement

Episode 24: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 

https://www.dentalproductsreport.com/view/episode-24-the-cellerant-awards-lasers-in-dentistry


https://www.dentalproductsreport.com/view/episode-23-raising-awareness-for-smile-for-a-lifetime

https://www.dentalproductsreport.com/view/episode-22-the-cost-of-cutting-corners


Podcasts

ProdPod Episode 26: The State of Restoratives

Making the most out of a difficult global situation, Dentsply Sirona held its Denstply Sirona World event last week as a virtual event rather than the typical in-person conference at a popular venue like Las Vegas.

At a media reception for Denstply Sirona World earlier this month, the company talked about the new format brought on by the pandemic, and shared plans for some of the newer education opportunities such as virtual lectures for dentists and lab technicians, as well as on-demand education that also included live surgical demonstrations.

Exceptional circumstances require exceptional changes, is the way the company describes this year’s event. Dentsply Sirona World, the “Ultimate Dental Meeting”, took place completely online from November 13-20. More than 4,500 dentists, dental technicians and practice teams registered for the over 70 courses in almost all practice-related disciplines. Live surgeries were special highlights that had the attention of the audience.

With lectures on a variety of topics, inspiring breakout sessions, and motivating speakers, the virtual Dentsply Sirona World delivered online education with its versatile program. In his opening speech, Don Casey, CEO of Dentsply Sirona, emphasized the company's commitment to provide participants with comprehensive support in offering their patients the best possible dentistry. A theme throughout the week was that dentistry is truly essential. Dental professionals from more than 25 countries attended to the courses, demonstrating that even in times like these, the dental world stands together and takes its responsibility for a healthy smile of its patients, Casey summarized.

The transformation to a new digital era in dentistry is also determined by people’s daily attitude in their (dental) businesses. This idea is where Simon Sinek, best-selling author and motivational coach, started his keynote at the opening event. He encouraged regularly questioning one's own daily routines and beginning to look at them as an “infinite game.” This would have the advantage of being able to change rules and help each other instead of getting stuck in old habits; it is important not to lose sight of the long-term perspective. These perspectives can help all dental professionals become even more successful in practice and also gain confidence.

Virtually brought up to the current state of research

For one week, lectures and presentations were available online and gave an overview of the current state of the art of dentistry. Lots of behind-the-scenes work took place to get Dentsply Sirona World 2020 to its final state and numerous sections were recorded in advance at the Academy in Charlotte. More than 80 people filmed 700+ hours in 12 weeks across six time zones and put together the final program, which is unique in this form, the company says. Additionally, more than 70 key opinion leaders were involved and covered topics from digital imaging, restorative and preventive dentistry to implant dentistry, endodontics, orthodontics, as well as hygiene and practice management. One of the most impressive highlights were the live surgeries, one of which was put online every day. Renowned experts such as Dr Mike Skramstad, Dr Meena Barsoum, Dr Douglas Smail, Dr Dan Butterman, Dr. Farhad Boltchi and Dr Diwakar Kinra provided an intimate look over their shoulders during implant, restorative and endodontic treatments.

 had a chance to interview some of these key speakers so look for podcasts and additional articles soon.

Workflow solutions for greater safety and business efficiency

The online-learning was also a new situation for the lecturers, which they solved with great poise.

Sameer Puri, DDS, Vice President for clinical education at CDOCS, who moderated the main program, liked what the format offered to all involved. "The colleagues have impressively shown that online education works perfectly and offers participants real added value. As a moderator, I also learned a lot", he says.

Dentsply Sirona's contribution is reflected in the functionality of the numerous innovations that were presented in the lectures, breakout sessions and surgeries. The focus was primarily on digital solutions. One of these is the new Axeos X-ray unit, which features a particularly large field-of-view and ultra-sharp images at the lowest possible radiation dose.

Primescan, the heart of a dental practice, also received a lot of attention. Thanks to its easy handling, the fast scanning process and its high accuracy, the intraoral scanner offers the perfect starting point for further digital workflows.

While the event was well received, Casey states that the company is looking forward to meeting personally again next year with its customers and partners in Las Vegas.

Pandemic causes annual event to go virtual with lectures and live surgeries, offering over 70 courses.   

Denstply Sirona World Goes Virtual and Delivers Exciting, Educational Program Focused on Efficient Workflows 

Bruce Bryen is a certified public accountant with over 40 years of experience and is a part of RKG Tax & Business Services LLP, an affiliate or Robin Kramer & Green, with offices in Marlton, New Jersey and Fort Washington, Pa. He specializes in deferred compensation, such as retirement planning design; income and estate tax planning; determination of the proper organizational business structure; asset protection and structuring loan packages for presentation to financial institutions. He is experienced in providing litigation support services to dentists with Valuation and Expert Witness testimony in matrimonial and partnership dispute cases. He is also a financial writer for several dental journals. You may contact him at 215-641-8300 ext 123 or at bbryen@rkgcpa.com, or through www.Bryen-BryenLLP.com.

It certainly appears that the dental service organization (DSO) is the trending concept in dental practices today. Is there a standard or an accepted number of dental practices needed to start up the DSO and make it viable from the beginning?

What exactly do interested dentists look for in this undertaking because it is a very hot topical item and the financial rewards, if properly managed, are quite high? There is really no number that is a definite answer to the question of how many, but it certainly helps to have as many as possible from an economic standpoint. If a dentist owns 2 or 3 practices, that is a good number to start as well.

An important first step is to determine the value of what the dentist is starting with and to do that, perform a dental practice valuation. The reason for this is to make sure that all of the practices are evaluated with consistency. Once the value has been determined, others may join based on the same format of value but with different entering requirements. The payment for those joining after the initial start-up will have different pricing schedules for payment and acceptance into the DSO, as well as varying roles to play in it.

Here are some examples of formats for joining DSOs and valuation of the initial dental practices, as well as caution in not making mistakes

If cash is the initial contribution, it is easy to determine the value because it is today’s money and can not be misconstrued. If the payment is based on a subscription or some type of formatted payment terms, determine the present value of those payments to decide what has really been contributed as the initial capitalization. For example, if $50,000 in cash is contributed in a lump sum at the closing date of the DSO as an initial capital contribution, the value of that amount is $50,000. Suppose that$50,000 is contributed to the DSO over 5 years at the rate of $10,000 per year plus 6% interest. Is that the same value as the lump sum of $50,000? The answer is no. The present value of that 5-year annual contribution is about $45,000. Not counting the value of the dental practices, one of the partners has contributed $50,000 in capital and the other about $45,000.

The consistent methodology and normalization of profit items for add backs in determining what the dentist is really taking home is important in determining a formula for adding dentists and dental practices. What is needed or not needed to operate the practices? Those items should determine the add backs to profit. These determine what each dentist is contributing to the value of his or her dental practice.

Valuations prepared by different evaluators with varying methods and profit normalization formats are a mistake. The difference in evaluators will cause a problem with the first contributions of dental practices as to their values. It will also cause future acquisitions in determining a dental practice value based on various constants and not consistent methodologies to create havoc with advisors. The next dental practices to join the group must have a basis that is easily understood because they will probably each have their own advisors who will look for holes in the presentation. That will cause delays in acquisitions and a lack of goodwill to those dentists who may consider joining with their practices or as individual practitioners. The number of practices owned by each contributing dentist is not the most important point in determining the value being contributed to capital.
The value of the practices being contributed is the answer so that someone with 2 practices may have more value than a dentist with 4.

Approximately how much is needed to start the DSO and who must be hired to assist in its organization and continued operations?

Although there is no magic number, consider lot of factors to ensure financial success for all parties involved.

ProdPod Episode 26: The State of Restoratives

Denstply Sirona World Goes Virtual and Delivers Exciting, Educational Program Focused on Efficient Workflows

What does it take to start a dental service organization?

Lab Tests Show Some Colgate Toothpaste and Mouthwash Neutralize SARS-CoV-2 Virus

Global CEREC Online Congress Set for Dec. 3-5