2013 wmdds spring bulletin

SPRING ISSUE 2013VOL. 45, NO. 3

Bulletin

is PROUD TO sPONsOR

T h e L a b o r a t o r y N e t w o r k

DSG Americus Dental Lab is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement. The current term of approval extends from 6/1/12 to 5/31/14.

DATES/LOCATIONS:Friday, September 13, 2013Frederick Meijer Gardens and Sculpture Park1000 East Beltline Ave NEGrand Rapids Charter Township, MI 49525

REGISTRATION & CONTINENTAL BREAKFAST:8:00 a.m. – 9:00 a.m.

PROGRAM:9:00 a.m. – 3:30 p.m.

HOW TO REGISTER:Online – register at dentalservices.net/davisramseyBy phone – contact Sue Isenga at 616-261-9191By email – [email protected]

PAYMENT:Payments can be made in advance or in person by check or credit card ONLY. If mailing a check, please include your first and last name, name of your practice, contact information, and the names of attendees with your check. Make checks payable to DSG Davis Laboratory and mail to:DSG Davis Dental LaboratoryATTN: Sue Isenga5830 Crossroads Commerce PkwyWyoming, MI 49519

COST:$225 per doctor | $125 per staff memberRSVP by September 6, 2013.RegisteR by July 1st and Receive $25 off youR tuition!Registration fees include continental breakfast, luncheon and handout materials and an open pass to the Frederick Meijer Gardens until 5:00 pm on the day of the seminar.

TERMS AND CONDITIONS:• Registrations are not considered final until payment is received in full• DSG Davis Laboratory reserves the right to cancel seminars that do not meet

minimum enrollment expectations• The registration fee will be refunded in full if DSG Davis Laboratory cancels the seminar• Attendee will receive 100% refund of the registration fee if attendee cancels four

weeks or more prior to the seminar

Course overview:Knowledge of dental materials and the most advanced products is necessary to maximize the success of your practice. This presentation is appropriate for dentists and their clinical staff members.

• IPS e.max®—whats the latest and greatest?• Full-contour zirconia is here to stay!• Understanding the Cadent™ iTero™ and the new True Definition Scanner from

3m™ and the benefits of both systems.• Incorporating the use of these scanners in implant dentistry.• Highlighting the latest ceramic systems, including the pros and cons of each.• Understanding the latest cementation options and their indications.• Addressing the latest adhesives—what is working and what is not.• Restorative and biological guidelines for implant dentistry.

Dr. Christopher ramsey, DmDChristopher D. Ramsey was raised and currently practices in Jupiter, Florida. His practice focuses on comprehensive esthetic and restorative dentistry. Dr. Ramsey received his dental degree from Temple University school of Dentistry in Philadelphia, Pennsylvania in 1999.

Dr. Ramsey is an accredited member of the American Academy of Cosmetic Dentistry and is also an Alumnus of the Pankey Institute in Key Biscayne, Florida. He is on the editorial review boards for the AACD Journal of Cosmetic Dentistry and the Journal of Implant and Restorative Dentistry. He has published numerous articles on customer service related topics, adhesive technology and cosmetic dentistry in several publications such as the Journal of Implant and Restorative Dentistry, Journal of Esthetic and Restorative Dentistry, PPAD, Dentistry Today, Contemporary Esthetics, Signature, and the Dental Products Report. Dr. Ramsey is a product consultant for The Dental Advisor, and to numerous dental manufacturers, garnering greater insight into the newest materials and techniques. He also has the unique opportunity to lecture both nationally and internationally on cosmetic dentistry and the elements needed to create successful, esthetic-based practices.

Dr. Ramsey takes over 200 hours of continuing education a year to stay on the cutting edge of cosmetic dentistry, which is a rapidly changing profession. He is the past President of The Florida Academy of Cosmetic Dentistry.

Predictable ProceduresFrom A To Z

LUNCHEON:12 p.m. – 1 p.m.

DSG Davis Dental Laboratory5830 Crossroads Commerce PkwyWyoming, MI 49519

PReSenTeD By: Dr. Chris ramsey FRIDAy, SePTemBeR 13, 2013 | 6 Ce CReDITS


WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 1

Contents

President’s Message ..................................................................................................... 2

Editor’s Thoughts ........................................................................................................ 3

Trustee Report ............................................................................................................. 4

A Brief Primer and Literature Review on Crown Surgery ........................................ 8

Technically Speaking ...................................................................................................16

Practice Management ..................................................................................................20

Classified Ads ...............................................................................................................22

Advertiser Index ...........................................................................................................23

WMDDS Summer CE Program ..................................................................................24

About the Cover

WMDDS Tooth Time event, February 2013.

Photo courtesy of Dr. David Huyser, chairperson of the Tooth Time event.

Mission StatementThe Bulletin is the newsletter of the WMDDS and its mission is to inform the membership of

upcoming and recent events, state & local issues related to dentistry, and as a forum for its officers,

representatives, and members to discuss appropriate topics of interest to the membership.

Communication & Advertising PolicyThe Bulletin will publish submitted articles from members and others that relate to the practice of

dentistry, small business, social, or political issues affecting dentists, or other subjects of interest to

the membership. All published items are subject to space restrictions and the community standards

of the WMDDS. The editors reserve the right to reject any article or advertisement deemed

inappropriate and to edit submissions as they see fit.

Submission & Publication Policy: Articles and advertisements must be submitted no

later than the 1st of the month preceding publication date. The Bulletin has six publications:

the winter issue, spring issue, summer issue, directory issue, fall issue, holiday issue. Direct

submissions or correspondences to:

Dr. Jeffrey S. Smith • 3050 Ivanrest SW, Suite B • Grandville, MI 49418

Phone: 616.531.1554 FAX 616.531.6947 • Email: [email protected]

Include “Newsletter” in the subject line

Editor Dr. Jeff Smith

Associate Editors Dr. Seth Vruggink Dr. Derek Draft Dr. Aric Smith Dr. Brian Licari

Advertising Editor Elaine Fleming Executive Secretary WMDDS 511-F Waters Building Grand Rapids, MI 49503 (616) 234-5605 [email protected]

West Michigan District Dental Society Executive Board 2012-2013 President Dr. Tyler Wolf President-Elect Dr. Margaret Gingrich Vice President Dr. Samuel Bander Secretary-Treasurer Dr. Kathleen Ellsworth Editor Dr. Jeff Smith Immediate Past President

Dr. Larissa Bishop

Directors Dr. Steve Conlon Dr. Leonard Bartoszewicz Dr. Brian MulderArea Representatives

Kent County Dr. Michael Palaszek Ionia-Montcalm

Dr. John O’Donald

County Mecosta County Dr. Erick Perroud Ottawa County Dr. Meredith Smedley

MDA IV District Dr. Brian Cilla Trustees Dr. Colette Smiley

Big Rapids Dental Study Club OfficersPresident Dr. Erick Perroud Vice President Dr. Christa SternSecretary Dr. Christa SternTreasurer Dr. Erick Perroud

Holland-Zeeland Dental Society OfficersPresident Dr. Meredith Smedley Treasurer Dr. Robert Ankerman Secretary Immediate Past President

Ionia-Montcalm Dental Study Club OfficersPresident Treasurer Dr. Kirkwood Faber

Kent County Dental Society OfficersPresident Dr. Norman Wilhelmsen Vice President Dr. Michael Palaszek Secretary Dr. Kathryn SwanTreasurer Dr. James Papp

West Michigan Dental Foundation OfficersPresident Dr. John Marshall Vice President Mrs. Wendy Mc Ginnis Secretary Mrs. Carol Klein Treasurer Mr. Joe Van Laan

The Bulletin of the West Michigan Dental Society is published six times a year (the winter issue, spring issue, summer issue, directory issue, fall issue, and holiday issue). The opinions expressed in The Bulletin are not necessarily the opinions of the West Michigan District Dental Society.

Contributions to The Bulletin are welcome and should be addressed to The Bulletin Editor, 3050 Ivanrest SW, Suite B, Grandville, MI 49418. Requests for purchase of advertising space should be directed to the Advertising Editor, Elaine Fleming, (616) 234-5605. The deadline is the 1st of the month prior to publication.

© 2012-2013 West Michigan District Dental Society Bulletin

is PROUD TO sPONsOR


DSG Americus Dental Lab is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement. The current term of approval extends from 6/1/12 to 5/31/14.

DATES/LOCATIONS:Friday, September 13, 2013Frederick Meijer Gardens and Sculpture Park1000 East Beltline Ave NEGrand Rapids Charter Township, MI 49525

REGISTRATION & CONTINENTAL BREAKFAST:8:00 a.m. – 9:00 a.m.

PROGRAM:9:00 a.m. – 3:30 p.m.

HOW TO REGISTER:Online – register at dentalservices.net/davisramseyBy phone – contact Sue Isenga at 616-261-9191By email – [email protected]

PAYMENT:Payments can be made in advance or in person by check or credit card ONLY. If mailing a check, please include your first and last name, name of your practice, contact information, and the names of attendees with your check. Make checks payable to DSG Davis Laboratory and mail to:DSG Davis Dental LaboratoryATTN: Sue Isenga5830 Crossroads Commerce PkwyWyoming, MI 49519

COST:$225 per doctor | $125 per staff memberRSVP by September 6, 2013.RegisteR by July 1st and Receive $25 off youR tuition!Registration fees include continental breakfast, luncheon and handout materials and an open pass to the Frederick Meijer Gardens until 5:00 pm on the day of the seminar.

TERMS AND CONDITIONS:• Registrations are not considered final until payment is received in full• DSG Davis Laboratory reserves the right to cancel seminars that do not meet

minimum enrollment expectations• The registration fee will be refunded in full if DSG Davis Laboratory cancels the seminar• Attendee will receive 100% refund of the registration fee if attendee cancels four

weeks or more prior to the seminar

Course overview:Knowledge of dental materials and the most advanced products is necessary to maximize the success of your practice. This presentation is appropriate for dentists and their clinical staff members.

• IPS e.max®—whats the latest and greatest?• Full-contour zirconia is here to stay!• Understanding the Cadent™ iTero™ and the new True Definition Scanner from

3m™ and the benefits of both systems.• Incorporating the use of these scanners in implant dentistry.• Highlighting the latest ceramic systems, including the pros and cons of each.• Understanding the latest cementation options and their indications.• Addressing the latest adhesives—what is working and what is not.• Restorative and biological guidelines for implant dentistry.

Dr. Christopher ramsey, DmDChristopher D. Ramsey was raised and currently practices in Jupiter, Florida. His practice focuses on comprehensive esthetic and restorative dentistry. Dr. Ramsey received his dental degree from Temple University school of Dentistry in Philadelphia, Pennsylvania in 1999.

Dr. Ramsey is an accredited member of the American Academy of Cosmetic Dentistry and is also an Alumnus of the Pankey Institute in Key Biscayne, Florida. He is on the editorial review boards for the AACD Journal of Cosmetic Dentistry and the Journal of Implant and Restorative Dentistry. He has published numerous articles on customer service related topics, adhesive technology and cosmetic dentistry in several publications such as the Journal of Implant and Restorative Dentistry, Journal of Esthetic and Restorative Dentistry, PPAD, Dentistry Today, Contemporary Esthetics, Signature, and the Dental Products Report. Dr. Ramsey is a product consultant for The Dental Advisor, and to numerous dental manufacturers, garnering greater insight into the newest materials and techniques. He also has the unique opportunity to lecture both nationally and internationally on cosmetic dentistry and the elements needed to create successful, esthetic-based practices.

Dr. Ramsey takes over 200 hours of continuing education a year to stay on the cutting edge of cosmetic dentistry, which is a rapidly changing profession. He is the past President of The Florida Academy of Cosmetic Dentistry.

Predictable ProceduresFrom A To Z

LUNCHEON:12 p.m. – 1 p.m.

DSG Davis Dental Laboratory5830 Crossroads Commerce PkwyWyoming, MI 49519

PReSenTeD By: Dr. Chris ramsey FRIDAy, SePTemBeR 13, 2013 | 6 Ce CReDITS


ince the plea for you to help people based on the

human condition has fallen on deaf ears, I will take

another tack…

You do know that there are way too many people in this

very community that are without the means to have dental

care.… Right? Please tell me you are aware of this.

Wouldn’t you rather choose to volunteer your time rather

than be made to? Or what about having someone trained to

do your job for you if you will continue to fail to step up to

the plate? I would think that you would have seen the writing

on the wall by now. If you don’t know what the term “access

to care” means to our profession, than you need to pull your

head out of that dark space and open your eyes. Have you

not witnessed already what is going on politically with health

care on a national level? Do you understand that dentistry is a

logical eventuality to be included with this downhill snowball?

Do you not understand that the very institutions that trained

you are now looking to instruct people that will be able to do

many of the things that you do – but more cheaply, and with

much less education?

I truly hope that this is not the first time that you are think-

ing about these things.

I know that there are many of you out there who are

already doing a lot. Whether it is within your own practice

or taking advantage of opportunities within your community

to give back, it is all an accomplishment that you should be

proud of. Unfortunately, you add up to a very small percent-

age of practicing dentists in this area. You are not to whom I

am speaking.

If you don’t know whether I am addressing you right now

or not, then I probably am. You need to start giving of your

time, and start making more of a difference.

At the risk of sounding dramatic and cliché, strong pow-

ers are at work to forge ahead with a “solution” to this access

problem – with or without our input as dental professionals.

This is being backed and funded by some entities with very

large and deep pockets. The research, testing, and training

are occurring as I write this; at both Schools of Dentistry in

Michigan.

Hopefully you are now asking, “What can I do?”

Here’s a list which is completely off the top of my head, in

no particular order, and in no way all inclusive:

• Mel Trotter Ministries

• Ottawa County Health Department – Miles of Smiles

Dental Mobile Unit

• Adult Dental Services Program

• Donated Dental Services

• MOM (Mission of Mercy) Project

We all have busy jobs, schedules, families, etc. You know that

you have no real reasons not to volunteer… only excuses.

Thanks for reading. It has been my privilege to serve as

your WMDDS President this year. Any questions, comments

or concerns, please feel free as always: [email protected] or

457-4600.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 20132

P R E S I D E N T ’ S M E S S A G E

What is Needed Expected of YouBy Tyler A. Wolf, DDS, WMDDS President

S


f memory still serves me correctly, it seems that back in

the dark ages after graduating from dental school and

opening up an office, most of my patients were reason-

ably healthy and the amount of medications that they took

regularly could be kept on a scrap of paper the size of a small

grocery list. Fast forward almost three decades, my patients

and I have grown older together, and for many, that short list

has become a thin book. As our patients routinely take more

and more prescription and non-prescription medications,

we have to be more mindful of how some of these drugs can

affect many of the procedures that we perform daily.

While the scope of all of the possible interactions between

dentistry and the drugs that our patients use (and may abuse)

is the subject of a textbook, this short article is meant to

focus on some of the more common “blood thinners” that

we see on our patient’s health histories. I’m sure that almost

everyone reading this has at some time successfully done what

appeared to be a routine extraction, or some other simple sur-

gical procedure, only to be surprised by how difficult it was,

or how long it took to get adequate hemostasis. In some of

these cases, the patient may not have been taking any known

thinner at all. As our patients mature, some are prescribed

anti-clotting agents in conjunction with histories of stroke,

heart attacks, atrial fibrillation, or prosthetic heart valves.

Many also receive these medications after the placement of

vascular stents or artificial joints.

While we learned the intrinsic and extrinsic clotting cas-

cades at one time, the bottom line is that there is no single

test that we can order or request be ordered for our patients

that covers all of the possible hemostasis complications that

can occur after dental surgical procedures. Some of the more

Life (and the Practice of Dentistry) Isn’t Getting Any SimplerBy Dr. Jeff Smith, WMDDS Editor

E D I T O R ’ S T H O U G H T S

common tests measure antiplatelet activity, which are sepa-

rate and unrelated to tests which measure the intrinsic and

extrinsic coagulation pathways.

Aspirin, NSAIDS, Plavix (clopidogrel), Ticlid (ticlopidine),

and Effient (prasugrel) all affect platelet function. Tests to

review would include: the Platelet Function Assay and Platelet

Count. Verify Now Aspirin is a new test that documents the

presence or absence of effective aspirin inhibition of platelet

activity. The Verify Now P2Y12 test measures platelet inhibi-

tion in patients using Plavix or related drugs.

Many of our patients are taking Coumadin (warfarin).

This drug affects vitamin K dependent clotting factors. The

Prothrombin Time (PT), and International Normalized Ratio

(INR) tests measure the extrinsic coagulation pathway, and

are appropriate for this medication.

Pradaxa (dabigatran) is a newer oral medication which

inhibits thrombin formation. It was introduced because

it eliminates the need for continuous PT/INR monitoring

which is usually necessary for patients taking Coumadin (war-

farin). The Activated Partial Thromboplastin Time (aPTT) or

Thrombin Time (TT) tests are used to measure its anticlotting

effect. PT/INR tests will not measure the effect of Pradaxa.

Many of the patients who take these anticlotting drugs may

be too sick systemically to undergo what would otherwise be

simple outpatient surgeries done in our offices. If there is any

doubt as to your patient’s health status, or you are uncertain

whether there may be a health risk or bleeding problem after

a procedure that you are recommending, do not hesitate to

contact the patient’s physician before performing the pro-

cedure. DO NOT advise your patient to discontinue taking

any physician prescribed medications in an attempt to better

control post-operative bleeding. Consider your local medical

laboratories as an information resource. They are more than

happy to answer any questions you may have concerning the

appropriate tests and ranges for your patients’ medications

and the procedures you are recommending. Finally, as new

medications arrive on the market and show up unrecognized

in our patients health histories and history updates, don’t be

afraid to ask your patient what the drug is for, why they are

using it, and what their daily dosage is.

I


s I write this current report, we are in the beginning

stage of March Madness (basketball and Washington,

DC). The MDA Annual Session is just around the

corner. This year’s event theme is the “Spirit of Michigan”

and will be in Novi on April 17-20. There are three days of

CE courses and nearly 200 exhibits. Please make plans to

attend this meeting. Of special note, Dr. Norm Palm will be

our incoming MDA President. May it be smooth sailing for

the next year. However, we all know that Norm will be ready

for anything that comes his way. Wish him success with his

tenure as the President.

This report contains highlights from the February Board of

Trustees (BOT) meeting.

MDA BudgetDetermining the annual budget for the MDA is a complex

process. Non-dues revenues, generated by the MDA Insurance

and Financial Group (IFG), are an important component of

the MDA annual budget. We are very fortunate that MDA-

IFG has experienced continued, ongoing growth over the

years. The revenues generated by these programs have pro-

vided significant dues relief for our members. At the pres-

ent time, the projected MDA budget is essentially balanced.

However, we are at a crossroad with the unknown. The

insurance exchanges dictated by the Affordable Health Care

Act may, or may not, impact a significant portion of our non-

dues revenues. As a consequence, at the most recent BOT

meeting, there was much discussion and deliberation regard-

ing the upcoming MDA budget. The Board has asked that

background information be sent to the 2013 MDA House of

Delegates (HOD) so that the delegates understand the timing

Highlights from February BOT MeetingBy Dr. Brian Cilla, MDA Trustee

and complexity of the issues facing the MDA with regard to

the proposed 2014 budget, the dues amount, and the need for

flexibility in the decision-making process. A resolution will be

forwarded to the 2013 HOD which would grant the MDA BOT

the authority to set the 2014 dues at up to the current 2013 dues

amount, for the purpose of maintaining a balanced budget.

MDA MembershipAt our last meeting, it was resolved that, for working life

members, the annual dues and contributions toward any

MDA assessments shall be 75% of an active member. This

policy is consistent with current ADA policy.

Nationally, the MDA remains at the forefront in providing

membership value. According to the MDA’s 2012 year-end

membership report, our Association ended last year with a

76.5% market share, up .3% from year-end 2011. 79.2% of

dentists under the age of 40 are members of the MDA.

MDA Governance Our MDA by-laws require a periodic review of governance.

At the present time, the MDA is operating with a governance

structure modeled in the 1970s. As a consequence, a work

group has been formed to review the MDA. Dr. Michael

Gallery is the consultant and facilitator for this group. A

meeting was held in January in order to begin discussions

on potential solutions to where MDA performance is versus

where the MDA should be (gap analysis). Recommendations

have not yet been formulated because there are many possible

solutions and the work group wants input from the House

and membership regarding the performance requirements

and gaps. As a preliminary step, the 2013 HOD will be asked

to adopt resolutions regarding these parameters. As part of

this process, Drs. Michael Gallery and Joanne Dawley will

provide a presentation to the House and there will be an

opportunity to ask questions. At the reference committee

hearing there will be testimony on the performance require-

ments and gaps. Once feedback is received from the House,

the work group will then be able to formulate solutions and/

or recommendations. These will be presented at the June BOT

meeting. It is anticipated that there will be a special meeting of

the House of Delegates on September 20, 2013 for the specific

purpose of governance review.

A

T R U S T E E R E P O R T


Department of Community Health The director of Michigan Department of Community Health

(MDCH), Mr. Jim Haveman, provided the BOT with an

update on the department. Mr. Haveman reviewed the

MDCH budget recommendation for 2014 and strategic

priorities. It was reported that Medicaid expansion is sup-

ported by Governor Snyder. This expansion will add 370,000

to Medicaid and provide health care for low income people.

Initially, 100% of the costs for this expansion will be funded

by the federal government for the first three years. At the

present time, there are 1.2 million uninsured individuals in

Michigan. It is anticipated that increased coverage will keep

these individuals out of the emergency rooms and also pro-

vide for medical homes. Adult dental care is not included

in this plan. As part of the process, a Federal/Sate Insurance

Exchange will be established. The Federal government will

be providing $30M to begin working on the Exchange. If

Michigan does not act on the $30M, the Federal government

will run the exchange and bill Michigan for costs associ-

ated with running the exchange. In order for this to occur,

Michigan must first create a new computer system. Michigan

will spend about $150M to upgrade its current system to be

compatible with the new exchange. It is anticipated that it

will take 3-4 years to get all of the kinks out of the system. A

question was raised as to how the department plans to work

with the Medicaid population in order for these individuals

to take personal responsibility for their own health care. Mr.

Haveman is aware that solutions for this complex problem are

difficult and that any and all ideas are welcome. He asked that

input be provided to Bill Sullivan, who can then relay them

to MDCH.

Healthy Kids Dental The Governor, on February 7, presented his 2014 state

budget. Previously, the Governor has proposed expanding

Healthy Kids Dental (HKD) program to the entire state.

Due to budget realities, the plan has been for an incremental

phase-in of HKD. There is an expected completion date of

2016. Ten counties were included with the first expansion in

2013. The proposed 2014 budget for HKD includes $11.6 mil-

lion, of which $3.9 million is from the state and $7.7 million

will be federal. It is anticipated that the following counties

will be added to HKD: Ingham, Ottawa, and Washtenaw. The

budgets for Donated Dental Services will remain same as last

year ($151,000). Adult Dental Medicaid will receive $7M in

state funds and $14M federal matching funds.

Mission of Mercy (MOM)Dr. Stephen Harris, chair of the MOM project, provided the

Board with an update on the 2013 project. The event will be

held June 7-8, 2013 at the Ryder Center at Saginaw Valley

State University. The MDA has exceeded its financial goals for

this 2013 event. Monies remaining will be transferred to the

2014 event. There are currently over 400 volunteers. Dental

volunteers are still needed. Dentists can sign up to volunteer

from the MDA’s website.

Future MOM projectsThe MDA Board has voted to do another MOM in May of

2014. If everything goes as planned, it will be held May 29

to June 1 at Ferris State University. It is anticipated that the

MDA Foundation will again partner with the MDA on this

venture. The MDA will be monitoring the success of these

projects in order to determine the frequency and locations

for future events.

Legislative AdvocacyEveryone has received a mailing from the MDA regarding the

importance of legislative advocacy. The MDA is encouraging

our members to be active in the political process. There is easy

access to contact information on the MDA website.

We have our next WMDDS Legislative Breakfast on

Friday, April 26, 2013 at Frederik Meijer Gardens & Sculpture

Park. Please mark your calendar and make plans to attend this

year’s WMDDS Legislative Breakfast. This is an important

opportunity for you to meet local legislators and express your

views and concerns on the issues that affect dentistry. Please

make every effort to attend. Dentistry’s voice needs to be

heard by our local representatives.

Since access to care has become such a prevalent local

and national topic of discussion, the MDA plans to hire our

current intern, Stephanie Olds, to promote the many good

things that dentists are doing in their communities. She will

be attending local components to cover access events and



continue to send MDA Twitter feeds. Additionally, Stephanie

will work with local components on creative marketing

opportunities.

Topics of Local InterestThe Kent County Health Department (KCHD) has reported

that the funding is in place to begin construction of the new,

ten-chair dental clinic in Kentwood. Spectrum Health has

funded a “dedicated chair” at the KCHD Clinic for Spectrum

Emergency Department dental referrals.

Blue Cross has given a $200,000 grant to establish a new

dental program at the Federally Qualified Health Center oper-

ated by Saint Mary’s Health Care. The FQHC clinic, operated

by the Peoples Health Centers of Michigan will include five


2013 New Dentist Forum Golf OutingFriday, September 6 — Noon Shotgun

(the first week back at school when you can roll a bowling ball through our offices and not hit anyone!)

Quail Ridge Golf Course in Ada

Loads of prizes, contests and fun!

Registration forms to be mailed in June

For sponsorship information, contact Devin Norman: [email protected]

operatories and will be located at Hope Network’s campus

on 36th Street. The People’s Health Centers of Michigan is a

non-profit collaboration of Saint Mary’s Health Care, Hope

Network, and Metro Health.

FinishAs always, I welcome any questions, concerns and/or com-

mentary regarding the activities of the MDA. Do not hesitate

to call, write or e-mail ([email protected]). In the meantime,

enjoy the longer days and any of our nice spring weather.

Legislative Breakfast

Friday, April 26, 2013Frederik Meijer Gardens & Sculpture Park

1000 East Beltline NEGrand Rapids, MI 49525

Please mark your calendar and make plans now to attend the WMDDS Legislative Breakfast.

This is an important opportunity for WMDDS dentists and local legislators to meet and express views

and concerns on the issues that affect dentistry. Please make every effort to attend.

To reserve your place, please complete and return the attached form by April 18, 2013.

Name

Email address

Breakfast Buffet will be served starting at 8:00 am

Cost: $16 per person

Please make check payable to: West Michigan District Dental Society

Return by April 18, 2013 to:

West Michigan District Dental Society

161 Ottawa Avenue NW Suite 511-F

Grand Rapids, MI 49503

Questions? Contact Elaine Fleming

616.234.5605 | [email protected]

or

Dr. Steve Dater, WMDDS Legislative Chairperson

616.866.0869 | [email protected]


ow often has one of your patients asked you if

there is anything that can be done to make their

teeth look larger or their smile less gummy? We all

have patients with short clinical crowns and/or a high lip line

that exposes a broad band of gingival tissue when they speak

or smile. Crown lengthening surgery can be done to increase

the length of the maxillary teeth in an apical direction, and at

the same time decrease the amount of visible gingiva. Crown

lengthening surgery is also used in situations of sub-gingival

decay, crown fractures, altered passive eruption, severe attri-

tion, or where the height of the crown is deemed inadequate

for retention without extending the restoration deep into the

periodontal tissues.1,2,3

In 1961, Garguilo defined the biologic width as the com-

bined width of the epithelial and underlying connective tissue

attachments that comprise the dentogingival junction. Since

each averaged 1mm, the biologic width was about2mm with a

gingival sulcus about 0.7mm deep.4 Nevins and Skurow included

the gingival sulcus depth, so the biologic width became ap-

proximately 3mm.5 Any impingement of the biologic width

by a restorative margin can result in gingival inflammation,

pocket formation, and alveolar bone loss.6,7,8 Gingival health

and form after placing a sub-gingival restoration depends

upon non-impingement of the biologic width, tooth shape,

and a smooth, continuous emergence profile that does not

disrupt the cervical wall of the supra-crestal gingival tissue.

When crown lengthening is done to alter the shape and

size of maxillary teeth, it can involve gingivectomy, osseous

surgery, orthodontic extrusion, or any combination of these.

Before proceeding with any periodontal or restorative treat-

ment, the following factors must be considered:

A Brief Primer and Literature Review on Crown Lengthening SurgeryBy Dr. Jeff Smith, WMDDS Editor

C L I N I C A L N E W S

1. Location of the gingival margin in relation to the CEJ and

alveolar crest,

2. Crown to root ratio, short tapering roots, and alveolar

bone relationships,

3. The size and shape of the upper lip,

4. The location of the lip line during speech and relaxed smiling,

5. Aesthetics,

6. Predictability and maintainability, and

7. Comparison of the adjacent periodontium to provide

a continuous transition between lengthened and non-

lengthened teeth.9,10

If the width of the free gingiva is greater than 1mm (i.e. the

clinical crown is shorter than the anatomical crown), and the

patient displays a periodontium of the thin biotype, then full

exposure of the crown may be possible with gingivectomy.

If the periodontium is of the thick biotype, then an apically-

positioned flap (with osseous surgery if necessary) should be

done. In patients with short anatomical crowns, more exten-

sive bone reduction and root exposure may become neces-

sary. Crowns or veneers then must be used to increase the

apical-incisal dimension of the clinical crowns.

Patients with normal occlusion and incisal guidance should

not have the positions of their incisal edges altered. Their

crowns are made longer by surgically exposing root structure,

and the cervical margins of the restorations are placed on the

roots. Crown length is then limited by the aesthetic height to

width ratio of the teeth. In patients who exhibit an anterior

overbite, the incisal edges of the teeth may be repositioned

apically in addition to the cervical margins to preserve an

ideal height to width ratio of 1.2 to 1 without interfering with

incisal guidance.11

Bony recontouring alone may not be the best choice for

single teeth, especially in the maxillary anterior region where

symmetry is critical, or where removal of bone from adjacent

teeth should be avoided. In these cases orthodontic extrusion

can be used to bring the tooth down to a distance equal to or

slightly greater than the portion of sound tooth structure that

will be exposed with subsequent osseous surgery. This extru-

sion can be slow or rapid.12,13,14,15 After bony crown lengthen-

ing is completed on extruded teeth, the final position of the

free gingival margin is harmonious with the adjacent teeth.

H


When crown lengthening is performed, a 3 to 4mm dis-

tance between the alveolar crest and the restorative margin is

essential to allow the necessary space for healthy dentogingi-

val tissue. In the absence of periodontal disease, transcrevicu-

lar probing or “sounding” with local anesthesia can be done

to insure that there is adequate distance between the proposed

restorative margin and alveolar crest after crown lengthening

is completed. Margins should be placed halfway down the

sulcus or about ½mm if possible.16

Bragger and others have demonstrated that a 3mm biologic

width remains stable up to 6 months.17,18 Other studies have

reported that there can be 1mm or more gingival “rebound”

coronally, especially in thick tissue biotypes.19,20 In aesthetic

cases, it may be prudent to keep patients in temporaries for an

adequate time period (normally 12-14 weeks) to insure that

the free gingival margins are in their final position before final

restorative margins are placed and impressions taken. Wound

healing studies in monkeys suggest that the biologic width

re-establishes itself following crown lengthening procedures.

The junctional epithelium will migrate to the level of root

planning, and the space for supra-crestal connective fibers is

created by resorption of alveolar bone.21

When crown lengthening is done, the final alveolar contour

should parallel the CEJ or proposed margin of the restoration.

On posterior teeth the alveolar bone should be relatively flat,

whereas the bone around anterior teeth will assume more of

a “saddle” form, being more coronal interproximally, as it

circumscribes the tooth.22

One of the most difficult challenges in periodontics and

aesthetic dentistry is closing or repairing areas where the

papillae have receded or are not present due to excessive

interproximal distance between the teeth. There are no pre-

dictable ways to graft or rebuild these papillae once they are

gone. Tarnow stated that if the interproximal contact points

of the teeth are within 5mm of the alveolar bone, the papillae

will usually regenerate and fill any “black triangles.” 23 This

should be kept in mind during the surgical phase so that no

more interproximal bone is removed than necessary. Black

triangles can be closed by raising the interproximal contacts of

the crowns apically, however, this can cause the teeth to look

unaesthetically “square.” This is especially true in patients

whose natural crowns are more round or “bell” shaped.

In an ideal aesthetic situation in the anterior maxilla, the

height-to-width ratio of the crowns should be between 1-1.2

to 1. The central incisors should be symmetrical, and in line

in height and position. The heights of contour at the cervical

areas should be located at the disto-labial line angle to avoid

the appearance of “chiclet-like” teeth. The free gingival mar-

gins of the cuspids and centrals should all be on one line that

parallels another line bisecting the patient’s pupils. The free

gingival margins of the laterals should be 1-1.5mm incisal to

those of the cuspids and centrals.24

Finally, when treatment planning a case for aesthetic

crown lengthening, it is helpful to gather photos of your

patient while smiling, when their lip is at rest, as well as with

cheek retractors. Upper and lower study models are useful

for determining incisal guidance. A diagnostic wax up on

the models can also be used to present the proposed case to

the patient. Radiographs are also necessary to verify that if

osseous surgery is required for the case, that the crown to

root ratio of the teeth to be lengthened, or the bony support

around adjacent teeth is not compromised.

Bibliography1. Smukler H, Chaibi M, Periodontal and Dental Considerations in

Clinical Crown Extension: A Rational Basis for Treatment. IJPRD 1997:

17:465-477.

2. Carranze, F. (1990) Glickman’s Clinical Periodontology, 7th Edn.

Philadelphia: W.B. Saunders Company, pp. 921-923.

3. Cohen, E. (1994) Atlas of Cosmetic and Reconstructive Periodontal

Surgery, 2nd Edn. Philadelphia: Lea and Febiger, pp. 263-383.

4. Garguilo A, et al, Dimensions of the Dentogingival Junction in Humans.

JPerio 1961; 32:261.

5. Nevins M, Skurow A, The Intracrevicular Restorative Margin, the

Biologic Width, and the Maintenance of the Gingival Margin. IJPRD

1984; 4:31.

6. Newcomb G, The Relationship Between the Location of Subgingival

Crown Margins and Gingival Inflammation. JPerio 1974; 45:151-154.

7. Bensimon G, Surgical Crown – Lengthening Procedure to Enhance

Esthetics. IJPRD 1999; 19:332-341.

8. De Waal H, Castelluci G, The Importance of Restorative Margin

Placement to the Biologic Width and Periodontal Health. Part 1. IJPRD

1993; 13:461-471.

9. Lindhe, J. (1989) Textbook of Clinical Periodontology, 2nd Edn.

Munksgaard, pp. 487-496.

10. Rosenberg E, Garber D, Tooth Lengthening Procedures. Compen.

Contin. Ed. Gen. Dent. 1980; 1:161.



11. Garber D. (1987) Periodontal Esthetics Problem Solving-Unique

Problems Require Unique Solutions. Presentation, D. Walter Cohen

Periodontal Symposium, University of Pennsylvania, Philadelphia.

12. Pontoriero R, et al, Rapid Extrusion with Fiber Resection: A combined

Orthodontic-Periodontic Treatment Modality. IJPRD 1987; 7:30-43.

13. Reitan K, Clinical and Histologic Observations on Tooth Movement

During and After Orthodontic Treatment. American Journal of

Orthdontics 1967; 53:721-745.

14. Ingber J, Forced Eruption: Part 1. A Method of Treating Isolated One

and Two Wall Infrabony Osseous Defects – Rationale and Case Report.

JPerio. 1974; 45:199-206.

15. Guilford H, et al, Vertical Extrusion: A Standardized Technique.

Compen. Contin. Ed. Gen. Dent. 1984; 7:562-568.

16. Ingber J, et al, The ”Biologic Width”, a Concept in Periodontics and

Restorative Dentistry. Alpha Omegan 1977; 70:62-65.

17. Lanning S, et al, Surgical Crown Lengthening: Evaluation of the Biologic

Width. JPerio 2003; 74:468-474.

Mission Statement: An organization dedicated to the improvement of oral health through the

financial support of education and service programs to address the needs identified by the dental

profession and the communities it serves in Kent, Ottawa, Ionia, Mecosta and Montcalm counties.

MARK YOUR CALENDAR

West Michigan Dental FoundationAnnual Golf Outing

Friday May 31, 2013 Egypt Valley Country Club

Watch for registration forms to arrive in April.

18. Bragger U, Surgical Lengthenung of the Clinical Crown. J. Clin. Perio.

1992; 19:58.

19. Pontoriero R, Carnevale G, Surgical Crown Lengthening: A 12-Month

Clinical Wound Healing Study. JPerio 2001; 72:841-848.

20. De Waal H, Castelluci G, The Importance of Restorative Margin

Placement to the Biologic Width and Periodontal Health. Part 2. IJPRD

1994; 14:70-83.

21. Oakley E, et al, Formation of the Biologic Width Following Crown

Lengthening in Nonhuman Primates. IJPRD 1999; 19:528-541.

22. Davarpanah M, et al, Restorative and Periodontal Considerations of

Short Clinical Crowns. IJPRD 1998; 18:424-433.

23. Tarnow D, et al, The Effect of the Distance From the Contact Point to

the Crest of Bone on the Presence or Absence of the Interdental Dental

Papilla. JPerio 1992; 63:995-996.

24. Lowe R, Esthetic Restoration of the Maxillary Anterior Region: A Case

Report. IJPRD 1989; 9:354-363.


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Join your colleagues for great social events, a variety of topics and speakers and nearly 200 exhibits.

New this year — one hour “Hot Topic” sessions —more information coming soon.

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W. Choong Foong, PhDMary Govoni, RDA, RDH

Derek HeinTimothy Kosinski, MS, DDS

Glenn LombardiSusan Maples, DDSAlan Mead, DDS

Kenneth Myers, DDSWilliam Nudera, DDS, MsChristopher Smiley, DDS

Jon Suzuki, DDS, PhD, MBADomenica Sweier, DDS, PhD

Anastasia Turchetti, RDHStephen Ura, DDS

Kelli VrlaDaniel Ward, DDS

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Thursday, June 6, 2013Set up clinic

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For information contact Lori Kleinfelt or Andrea Sundermann at 800-589-2632 or via email at [email protected].


T E C H N I C A L L Y S P E A K I N G

n each WMDDS Bulletin I will be fielding your questions

about technology, its place in the dental practice, and beyond.

Send your questions to [email protected] and

I’ll answer them on my blog, facebook, and in each Bulletin.

I’m ready for a new computer. Windows 7 or Windows 8?My answer: Windows 7. Why? Windows 7 is stable, reli-

able, and considered to be the industry standard right now.

Support for Windows XP finally ended (and XP was released

12 years ago) so there is plenty of life left in Windows 7.

Now, Windows 8 is very cool and may someday become the

standard, but it may also suffer the fate of Vista and lead

a very troubled and short life. It’s too early to say at this

point. However, none of that matters nearly as much as

compatibility.

As you know, each of your software and hardware ven-

dors specify system requirements that your computers must

abide by in order to successfully use their product. Eaglesoft,

Dentrix, Softdent, Dexis, Tigerview, etc.… all have these

requirements – and guess what? Hardly any of them cur-

rently support Windows 8. How fast will that change? Good

question, that’s kind of like asking how long it will be before

Dentrix or Eaglesoft put any of the changes you’ve undoubt-

edly requested into their next update. Because we can’t pre-

dict or influence how fast and in what direction these vendors

move, Windows 7 is the safe bet for now.

Consider this as well: Windows 8 is basically brand new.

Remember back to one of the times you did your Practice

Management Software version update right away. Were there

bugs? Was it a headache? How long did it take before every-

thing worked the way you wanted to again? My approach is

that it just isn’t worth the hassle of being a first adopter. Sure,

Windows 8 has been tested as extensively as possible prior to

releasing to the public, but the best test of all (with any prod-

uct) is to release it to the public and see what happens. This

is why we have service packs and patches and such, to fix all

of the problems the first adopters were kind enough to find.

Someone has to be the first adopter, but I’d rather it not be

me or you.

Let’s be fair…Windows 8 is initially showing to have

great potential. I myself have it installed on my laptop in a

virtual machine environment and I have had no problems

with it. The interface is considerably different but in general

can be navigated by someone who can find their way around

Windows 7. I do think it’s going to take off in the next few

years, especially if the tablet market supports it.

Speaking of tablets, another plus for Windows 8 is its

interface for touchscreen monitors, laptops, or tablets.

Touchscreens on Windows 7 is a nice idea and works OK,

but Windows 8 is built for it. It’s more like using an ipad

but on your computer, it is just so much more intuitive

than Windows 7 for the touchscreen user. I am very excited

to someday use Windows 8 with touchscreens, navigating

between my 5 monitors (yes I’m that geeky) will be easier

when I can just touch the spot I want to go to rather than

mousing and mousing and mousing to get there. If you’ve

seen the Matrix or Avatar, those touch screen interfaces are

what I envision Windows 8 doing for the PC; it truly could

be a game changer. I also see these Windows 8 tablets as soon

being an answer to the demand for tablets in Dental Practices.

Notice I did say soon, we still have to wait on our good old

vendors to become Windows 8 compatible.

But Greg, what if I’m not going to use it in my practice at

all and just want to use it at home? I’ve pondered this myself,

which is why I have it running in a virtual machine on my

Windows 7 computer. If you like to tinker and enjoy the

adventure of new adventures, go for it! To keep a stable and

reliable Windows 7 computer intact, install Windows 8 in a

virtual environment or as a dual boot option. Then you get

the best of both worlds! For those of you who are perfectly

happy to let us curious souls figure it all out, keep enjoying

Windows 7, and your free time.

Windows 7 or 8?Submitted by Greg Feutz, President, DDS Integration

Greg Feutz is President of

DDS Integration, a

Grand Rapids based dental

technology company.

I


T E C H N I C A L L Y S P E A K I N G

What are your thoughts?Comment on our blog or facebook article. We’d love to hear

your opinions on Windows 7 vs. 8 or any other topic. If you

have tried out Windows 8, share your experience. We’re

excited to see what other people think!

Facebook: facebook.com/ddsintegration

Blog: ddsintegration.com/blog

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201318 HANC Ad for the Bulletin 2/13/13 Size: 7.5” wide x 3.25” high (One-third Horizontal) 1213-9813

Good Ideas for Dental Practices

Hungerford, Aldrin,Nichols & Carter, P.C.C P A S A N D C O N S U L T A N T S

Where Good Ideas Add Up.™

Good Ideain a series of 15

When it comes to building your practice,

experience matters. Our understanding

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provide services and expertise beyond the scope of most

accounting fi rms. We can help enhance the effi ciency and success

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Get to know us.

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#5“ Is your practice attractive to new associates?

Will they earn enough to aff ord the payments to you and/or the bank? When it is time for you to bring in an associate, analysis should be done to answer these questions.”

For 14 more Good Ideas from Hungerford, please email Rick Chrisman at [email protected], or call Rick at (616) 949-3200.

177 (12/12) Canvas Office Landscape Planning Guide

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Why all the Fuss about Airways and Faces? John Mew knew he changed faces. We now know he changed much more than that. Join us as physicians from the medical and dental community come together to discuss the implications of a compromised airway in children, and the impact that Biobloc Orthotropics® has on long term health as well as esthetics. ! Speakers include: John Mew, Michael Mew, Michael Gelb, DDS, Allen Moses, DDS ( inventor of ‘the Moses” appliance for snoring and OSA), Stephen Sheldon, DO ( pediatric sleep medicine),Phil Losavio, MD- ENT, William Hang, DDS, Christine Mills, BS, John Flutter, DDS, Bertrand da Silva, MD

Fourfold increase in airway

Be InspiredMay 2-4, 2013

Allerton Hotel- Downtown Chicago

Pre-symposium Thurs. 1-5 pm Dentists: $190.00 Staff: $45.00

Main Symposium Fri. & Sat. 8-5pm Dentists: $1115.00 Staff: $375.00Continental Breakfast and Lunch included Fri. & Sat. Banquet Fri. evening included

Call the office of Karen O’Rourke, DDS for more information and

registration details. (616)455-7930


MemberGet AMember

Building the future of our profession … together!

Share why you belong to the #1 organization representing all dentists.

As an active member, you know first-hand the value of a strong ADA — greater recognition for the profession, more resources for members, and a louder voice in Washington and across the country.

Most ADA members say they would recommend membership to colleagues. Now, here’s your chance!

ADA Member-Get-A-Member

Any ADA member dentist is eligible to participate in the 2013 ADA Member-Get-A-Member Campaign.

With your help:

• The ADA benefits by being able to represent another member dentist.

• The new member you recruit benefits by taking advantage of all membership has to offer.

• You benefit by strengthening the ADA and sharing the value of membership with another colleague — plus there are incentives and prizes for recruiters! For details visit ADA.org/MGAM.

Recruiting is Rewarding

You will be rewarded with a $100 American Express gift card for each new, active member you recruit (up to five members or $500 in American Express gift cards)! Or you may decline the incentive and ADA will contribute $100 to the ADA Foundation. Please see Campaign Rules for full details at ADA.org/MGAM.

Participate in the 2013 Member-Get-a-Member Campaign and help build the future of our profession!

Don’t Delay! The ADA Member-Get-A-Member campaign runs through September 30, 2013. For resources to assist your recruiting efforts, plus complete guidelines and rules visit ADA.org/MGAM, send an email to [email protected] or call the ADA Member Service Center at 800.621.8099.


Do You Know What Your Dental Practice Is Worth?Submitted by Richard L. Chrisman, CPA MSTHungerford, Aldrin, Nichols & Carter, PC

P R A C T I C E M A N A G E M E N T

nyone who has ever bought or sold a dental prac-

tice knows that buyers and sellers often have a very

different perspective on what a practice is worth.

A seller typically believes that his/her practice is worth more

than it really is. Meanwhile, the buyer is looking for a bargain.

Since a sale cannot occur until a purchase price is agreed to,

both parties are often motivated to find a number that is fair

to everyone.

Unfortunately, there is no standardized generally accepted

method for valuing a dental practice. There is no rule

of thumb that enables someone to determine a fair value by

simply looking at a few numbers and making a calculation.

There is no “right” or “easy” way.

The reality is – determining a fair value of a dental practice

is a difficult task with many complexities. There are many

objective and subjective factors that need to be considered.

When a practice valuation is necessary, it is a good idea to get

a valuation expert involved. An expert knows what informa-

tion to look at and how to interpret it.

Common valuation methodsEvery practice is unique. The valuation method that should

be used to arrive at a fair value will depend on the facts and

circumstances of the particular practice. Although there

are many methods used to value a dental practice, most

approaches tend to fall into one of three categories:

1. Asset Based – This method calculates the value of the

assets of the practice being sold. This is often a good place

to start. It gives you an idea of what the cost would be

to start up a similar practice by purchasing the necessary

assets. The shortcoming of this method is that the income

and cash flow of the practice are not considered.

2. Market Comparison – This method identifies similar

practices that have been sold and applies certain ratios of

those recent practice sales to the practice being valued.

This is like determining the value of a house by looking at

what similar houses have sold for.

3. Income/Cash Flow Based – This method identifies the

cash flow being generated by the practice, and then the

cash flow is either capitalized, discounted or multiplied.

In most situations the experts tend to favor the Income/Cash

Flow Based approach because it recognizes the components

that are critical to the ongoing success of the practice. This

method will enable the buyer to purchase a practice for a price

that is based on the expected income and cash flows of that

particular practice. The buyer will also have a good under-

standing of his ability to make any required loan payments to

the bank or prior owner.

Some factors that need to be considered when doing a valuationValuation experts will look at the following items among others

when preparing a valuation of a practice.

11. The results reported on recent financial statements and

tax returns.

12. A list of equipment and an estimate of its value.

13. The cost and age of leasehold improvements.

14. A production and collection report by each dentist

and hygienist.

15. An accounts receivable aging and collections report.

16. Any contracts that are in effect.

17. The total number of active patients.

18. The value of intangible assets.

19. The economic and industry outlook.

10. What is the reason for the owner to want to sell the

practice?

Other considerations when buying or selling a practiceIt is common for buyers and sellers to get emotionally

involved in the negotiation of the purchase price. However,

the devil is in the details. Most compromises on value are ulti-

mately achieved through the terms of the agreement. Besides

A


P R A C T I C E M A N A G E M E N T

the purchase price, there are two other major issues that need

to be agreed to: 1) What exactly is being purchased? i.e. stock

or assets, and 2) What are the payment terms of the sale? i.e.

cash and/or financing.

The cash flow and tax effects can vary significantly (to both

the buyer and seller) based on the terms. Therefore, to be sure

there are no surprises later, you should involve your CPA in

the negotiation of the details of the transaction.

If you are selling a practice, make sure you know 1) What

cash you are going to receive from the buyer, 2) When are

you going to receive it? 3) How much in taxes will be owed?

4) When will those taxes need to be paid? and 5) How much

cash will you ultimately end up with after the taxes are paid?

Make sure you understand and are comfortable with all those

numbers.

If you are buying a practice, make sure you understand

what risks you are taking, the purchase price is fair, and you

know where the cash flow is going to come from to meet the

terms of the purchase. The purchase of a practice will not go

well for the buyer if he overpays for it or the terms are not

manageable.

Richard L. Chrisman, CPA, MST is the Managing Shareholder of Hungerford,

Aldrin, Nichols and Carter PC, a Tax, Auditing and Business Consulting

firm with offices in Grand Rapids and Greenville, MI. The firm is celebrating

71 years of helping local businesses, including many area dental practices.

The passion to do more.

Our local bank proudly supports theWest Michigan Dental Community.

Born here.

Growing here.

Staying here.

LocationsCascade Rd at Spaulding - SE

Northland Dr at Plainfield - NE Monroe Ave at Louis - Downtown

Wilson Ave at 56th - SW

(616) 956-9030foundersbt.com

Member FDIC

Specialties Include:

• Custom designed deposits• Equipment financing• Financing of partner buy-in and

practice purchase

• Flexible loan payments• Practice start-up loans• Real Estate Financing• Working Capital Lines of Credit


C L A S S I F I E D A D S

Established Dental Office Space –

2003 Burton SE (between Breton and

Plymouth). End unit with 720 sq. ft.

and a full basement, on-site parking,

adjacent 3 spaces occupied by estab-

lished dentists. Great traffic counts on

Burton in an established residential

area. Call Bruce at 942.9492.

Seeking Employment – General

dentist with several years of experi-

ence seeking part-time employment in

the West Michigan and surrounding

areas. Proficient in all areas of general

dentistry. A team player. Please reply to

[email protected].

Dental Office for Lease – Time to

move up? Busy northeast area dental

suite at 1750 Grand Ridge Ct. NE,

3295 SF, ten-year old modern dental

office available. 3 pvt ops, 4 chair bay

area, plumbed for nitrous, air, water,

power and vacuum, lab, x-ray, staff

area, pvt. office, reception, storage

available. Former pedo practice

obtainable Jan. 1st 2011. Contact

Dr. John Monticello 616.364.1700 or

[email protected]

Associate position wanted – Newly

graduated dentist from UDM looking

for full time position as an associate

of progressive dental practice in

Grand Rapids and surrounding areas.

Please call 616.617.9725 or email

[email protected].

For Sale – Lab Master Foster Model

Trimmer, Model # MT115, like new

$600. Contact 616.949.7510.

Dental Office for Lease – with imme-

diate availability. Near the “medical

mile” on primary road with high traffic

count and super visibility. Has been

a dental office for over 40 years. Very

good lease terms/rates. Would make

awesome start-up or satellite. For more

info, email [email protected].

General Dentist – Looking to purchase

a practice or pursue transition in

Grand Rapids area. Three years of

experience. Please email to:

[email protected].

Associate Position Wanted – Fourth-

year at University of Florida COD

and Michigan native seeking full-time

The classified ad rate is $10.00 up to and including 30 words; additional words 15¢ each. Space permitting, WMDDS members may

place ads free of charge as a membership service. Ads should be submitted in writing and sent with payment to Elaine Fleming,

WMDDS, 511-F Waters Building, Grand Rapids, MI 49503. Telephone numbers and hyphenations count as two words, abbrevia-

tions count as one word. Ads received after the first of the month prior to publication may appear in the following issue.

associate level opportunities in greater

Grand Rapids area beginning summer/

fall 2013. [email protected] or

248.568.0839.

Seeking employment – General den-

tist with eight years of experience

seeking part-time employment in

West Michigan area. Enjoys practicing

most areas of dentistry. Please email:

[email protected].

Dentist Needed – Full-time or part-

time at State of Michigan Correctional

Facility in Ionia, MI. Avoid headaches

of private practice. For information

please call Ken or Richard at

517.321.9313.

Ottawa County Health Department is currently in the process of recruiting a

part-time dentist to provide services on the county’s 40 foot, state-of-the-art

“Miles of Smiles” Mobile Dental Unit. The mobile unit provides compre-

hensive dental services at schools and Head Start Centers throughout Ottawa

County (Grand Haven, Holland, etc.). Please see attachment for additional

information regarding this exciting career opportunity!

Employment will involve 1-2 days per week (6 hours/day). Competitive wage.

If you are interested in this position, please e-mail a resume to:

[email protected].

Debra J. Bassett R.D.H., B.H.S.

Oral Health Team Supervisor

Ottawa County Health Department

12251 James Street, Suite 400

Holland, MI 49424

We look forward to hearing from you!


C L A S S I F I E D A D S

Beautiful, Professional Suite Available for Sale/Lease – N.W.

Michigan, lower peninsula, in a grow-

ing community. Great opportunity for

any dentist, with many extras. Ideal

location, safe and serene, for any

family. World-class cultural events,

restaurants and attractions nearby.

Sporting adventures abound.

Turn-key. Let’s talk. Call 231.313.8407

or [email protected]

Exciting Opportunities – for dentists

to provide children with dental care

in Grand Rapids area schools. No

evenings or weekends. Apply at

smileprograms.com or call Tracey at

888.833.8441, ext. 126.

Kavo Handpieces for Sale –

6000B have 5 at $400/handpiece,

6500B have 6 at $400/ handpiece,



649B have 2 at $200/handpiece.

Call 616-453-6323.

For Sale – Kavo GentleRay 980 Diode

LASER. Specializes in management

of all soft tissue procedures such as

gingival troughing, aphthous ulcer

treatment, and perio pocket treatment

as well as bleaching. Features a large,

bright touch screen with built in clini-

cial tutorials for easy practice integra-

tion. Like new, used approximately

15 times. Includes ALL accessories

needed for immediate use including

protective eyewear for doctor, patient

and assistant and 3 tips for handpiece.

Also includes rolling cart for portabil-

ity. Please call or email for details/

photos. Phone 616.606.3263, or email

[email protected]. Purchased

for approximately $10K. Asking

$5,500/obo.

Graduating dental student seeking

associate position in Grand Rapids or

surrounding areas beginning in early

June. Among the top performers of

graduating class and eager to bring

strong work ethic, collaborative nature

and attention to detail to your practice.

Business-minded professional and

committed to providing exceptional

dental care. Please contact Katelyn

Van Slyke at [email protected] or

616.540.6369.

Dental Dreams desires motivated,

quality-oriented associate dentists

for its offices in Muskegon, Saginaw

and Flint. We focus on providing the

entire family superior quality dentistry

in a modern technologically advanced

setting with experienced support staff.

Because we understand the tremendous

value of our associate dentists, we

ensure that their compensation pack-

age is amongst the best. Our average

colleague dentist earns on average

$230,000 per year plus benefits.

Please contact Danielle Tharp at

313.274.4524 or email

[email protected].

The Bulletin wishes to thank our valued

advertisers who support organized

dentistry by helping to defray the cost

of printing and mailing.

Advertising in the Bulletin is seen

by over 90% of the dentists in the

West Michigan District. This includes

five of the fastest growing counties

in the state: Kent, Ottawa, Ionia,

Montcalm and Mecosta.

For information on advertising rates,

call Elaine Fleming, WMDDS Executive

Secretary at 234-5605. Target your Market

– advertise in the Bulletin!

Beene Garter ......................................14

DDS Integration .... outside back cover

Davis Dental

Laboratory ............... inside front cover

Founders Bank & Trust ....................21

Great Lakes Financial Insurance ......17

Henry Schein ............inside back cover

Hungerford, Aldrin, Nichols &

Carter, PC ..........................................18

Keystone Pharmacy ..........................14

MDA IFG ...........................................11

ProAssurance.....................................13

A D V E R T I S E R I N D E X


Lunch & Learn with Hungerford Valuation

1. Are you an associate with plans to buy a practice? 2. Will you use the sale of your practice to fund your retirement? 3. Do you have an exit strategy or succession plan? 4. Have you considered bringing in an associate?

Practice valuation is more than just a rule of thumb. Hungerford Valuation will present an overview of dental practice valuation techniques. We will explore why practice value is important as well as how practices are valued. Participants will leave with an understanding of basic valuation concepts and tips you can use to improve the value of your practice. Please join Kerry A. Bean, CPA/ABV and Brandon Finnie of Hungerford Valuation for this free informative session. Kerry and Brandon have valued hundreds of privately-held businesses including dental practices. Topics of discussion will include:

Why It’s Important to Understand Your Practice’s Value • Succession Planning • Buy/Sell Purposes

Practice Valuation Overview Tips to Improve Your Practice’s Value

When: Friday, April 19th, 11:30 a.m. to 1:00 p.m. Agenda: 11:30-12:00 p.m. Registration and Lunch 12:00-1:00 p.m. Presentation Where: Hungerford, Aldrin, Nichols & Carter, PC – Cripps Training Room 2910 Lucerne Drive SE Grand Rapids, MI 49546

Register now by calling Sharon Whipple at HANC 616-949-3200 or via email at [email protected]. Reservations are required.

What is My Practice Worth?

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Call 616-791-2358 and ask for our Technology Specialist 3M is a trademark of 3M or 3M Deutschland GmbH. Used under license in Canada. ©3M 2013. All rights reserved. Please recycle. Printed in U.S.A.

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WEST MICHIGAN DENTAL SOCIETY

511-F Waters Building

Grand Rapids, MI 49503

PRSRT STDUS POSTAGE

PAIDGRAND RAPIDS, MI

PERMIT # 657

2013 wmdds spring bulletin

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