implant dentistry thrives outside the big city same office

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Aesthetic Dentistry Implant Dentistry rives Outside the Big City Same Office, Newer System, Better Profits Dento-facial Aesthetics: A New Paradigm in Dentistry TECHNOLOGY AND TRENDS IN THE FIELD OF AESTHETIC DENTISTRY • VOLumE 7 ISSuE 1 • WINTER 2008

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Page 1: Implant Dentistry Thrives Outside the Big City Same Office

Aesthetic Dentistry

Implant Dentistry Thrives Outside the Big City

Same Office, Newer System, Better Profits

Dento-facial Aesthetics: A New Paradigm in Dentistry

T E C H N O L O G Y A N D T R E N D S I N T H E F I E L D O F A E S T H E T I C D E N T I S T R Y • V O L u m E 7 I S S u E 1 • W I N T E R 2 0 0 8

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Aesthetic Dentistry T E C H N O L O G Y A N D T R E N D S

I N T H E F I E L D O F A E S T H E T I C D E N T I S T R Y

V O L u m E 7 I S S u E 1 • W I N T E R 2 0 0 8

About the Cover

SPONSORSHIP BY THESE COMPANIES HELPED MAKE THIS ISSUE POSSIBLE:

Arrowhead Dental Laboratory • BioResearch • Cadent • Captek • DEKA Dental Lasers Dentsply Caulk • Dentsply Prosthetics • Dentsply Tulsa • Ivoclar Vivadent • Officite

For advertising and sponsorship opportunities, contact Scott Henkel [[email protected]] (801) 572-7235

For subscription or address changes, contact Debi Evans [[email protected]] (801) 572-7244

Published quarterly by Centennial Publishing Inc., Orem, Utah [[email protected]]

EDITOR’S COMMENTARY Dick Made Me Do It Martin Stern, D.D.S.

IMPLANT EZImplant Dentistry Thrives Outside the Big City Schuyler VanDyke, D.M.D.

LAB PERSPECTIVE Presenting Value Hernán Varas, M.B.A.

SCIENCE & TECHNOLOGYDento-facial Aesthetics: A New Paradigm in DentistryNimmi Holstein, D.D.S.

INSIGHTSSame Office, Newer System, Better Profits Terri Bauer, R.D.H.

HOT PRODUCTS Communication and LoyaltyMark Olson

Contents • Winter 2008

ustin Caldwell had an irra-

tional fear of dental work, so

his number one question was,

“Will it hurt?” He was also afraid

that veneers would appear fake.

The reality was, it really didn’t

hurt and his teeth are incredibly

natural looking. See Justin’s story

on page 4.

Aesthetic dentistry by Dr. Chris

Stevens, Sun Prairie, Wisconsin.

Aesthetic restorations by Arrow-

head Dental Laboratory, Sandy,

Utah. Cover photo: Dirk Douglass

Photography, Salt Lake City, Utah

(dirkdouglass.com).

Aesthetic Dentistry n Winter 2008 3

Page 4: Implant Dentistry Thrives Outside the Big City Same Office

As a small child, Justin Caldwell lived in the metro areas of Salt Lake City and Philadelphia. But when he was twelve, his life experienced a cultural change: his family moved to the small town of Mantua, Utah—population 741. During that transition, Justin developed his fear of dentists.

“I got braces when I was eleven,” said Justin. “When I turned twelve my family moved and I switched orthodontists. The switch did not go smoothly. After five years, my braces were removed, leaving white calcification marks everywhere. I developed a bad attitude toward dental work and pretty much stayed away from dentists for several years.”

Over time, however, Justin became increasingly aware

of the necessity to have some major dental work done. “When I was young,” said Justin, “I tended to use my teeth as a multipurpose tool: ‘Can’t get that screw off with your hands? Here, let me try my teeth.’ This led to quite a few chips and gashes. I became somewhat self-conscious about my smile, and began to do the ‘closed-mouth smile’ for photographs. When I was dating my wife, she asked if she could see my teeth. I refused. My less-than-perfect smile caused me to smile less.”

Following marriage, Justin starting thinking about his smile. He got a part-time job at Arrowhead Dental Labo-ratory and became acquainted with the smile makeover business. But his fear of sitting in a dental chair prevailed, and he took no action. Following graduation with a degree in Information Systems, his part-time position at Arrowhead became a full-time job, and he started asking questions about restorations.

“I had an irrational fear of dental work,” said Justin, “so my number one question was, ‘Will it hurt?’ I was also afraid that veneers would appear fake. I pictured Chicklets in place of my teeth. The reality was, it really didn’t hurt and I believe my teeth are incredibly natural looking.”

Justin’s dental restoration was performed by Dr. Chris Stevens. “Dr. Stevens’ knowledge is extremely apparent,” said Justin. “He is educated in every aspect of dentistry, which gave me confidence that he could handle any situa-tion we encountered. The guys at the lab also did a great job verifying and re-verifying specifications. Everything went extremely well the day of the seating.”

Justin is a firm believer that his new smile affects the way others respond to him. “I know it sounds cliché,” he said, “but I’ve had people ask what is different about me. The biggest change, at least from my point of view, is that I am now confident about my smile.”

Justin’s phobia of dentists has undergone a dramatic change. “Modern cosmetic dentistry is easy and painless,” he said. “Don’t put it off because of irrational fears. Looking back, two appointments in the chair were such a small price to pay for a perfect smile.” n

Justin Caldwell has been a systems analyst for Arrowhead Den-tal Laboratory in Sandy, Utah, since 2005. He is involved with software development, database administration, help desk, and workstation/server maintenance and repair.

Before

After

A fear of dentists kept Justin Caldwell away from getting the confident smile he always wanted.

C O V E R S T O R Y n J u S T I N C A L D W E L L

Small Town Boy Gets Big City Smile

“I had an irrational fear of dental work, so my number one question was, ‘Will it hurt?’”

4 Aesthetic Dentistry n Winter 2008

Page 5: Implant Dentistry Thrives Outside the Big City Same Office

Improve Your Practice...Improve Their Smiles!This year, attend a professional seminar to improve your technique and expand your practice. Check the schedule below and call today to confirm your reservation. Call 1-800-800-7200 to register or inquire about courses from July to December.

Cosmetics: Incorporate the most advanced techniques and procedures in simplifying cosmetic dentistry through an Over-The-Shoulder and a Clinical Hands-on experience.

Practice Development: Learn to increase your production immediately and provide better dentistry to your patients without working harder!

February 29 . . . . . . . . Northeast Louisiana Dental Assoc. . . . . . .Bernice, LAMarch 7-8 . . . . . . . . . . Total Team Training . . . . . . . . . . . . . . . . . . .Nashville, TN March 7-8 . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Copenhagen, Denmark March 14 . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Louisville, KY March 28 . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Baltimore, MD April 18 . . . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Hershey, PA April 25 . . . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Cherry Hill, NJ May 2 . . . . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Aurora, IL May 9 . . . . . . . . . . . . . Clearfork Study Club . . . . . . . . . . . . . . . . . .Fort Worth, TXMay 9-10 . . . . . . . . . . Total Team Training . . . . . . . . . . . . . . . . . . .Sandy, UTMay 16 . . . . . . . . . . . . 8th District Dental Association . . . . . . . . .Du Bois, PAMay 30 . . . . . . . . . . . . Increase Your Production . . . . . . . . . . . . . .Des Moines, IA

Implant EZ: Discover how to take full advantage of the fastest growing opportunity in dentistry by implementing single-tooth implants effortlessly into your practice.

March 7-8 . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Minneapolis, MNMarch 28-29. . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Nashville, TNApril 4-5 . . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .St. Louis, MOApril 11-12 . . . . . . . . . . Bone Grafting . . . . . . . . . . . . . . . . . . . . . . . .McPherson, KS April 25-26 . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Copenhagen, DenmarkApril 25-26 . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . . .Detroit, MI May 2-3 . . . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Charlotte, NC May 9-10 . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Albuquerque, NMMay 30-31 . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Sun Prairie, WI May 30-31 . . . . . . . . . . OTS Implant EZ – Level II . . . . . . . . . . . . . .Dallas, TX June 6-7 . . . . . . . . . . . Sinus Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . .McPherson, KSJune 6-7 . . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Sandy, UT June 13-14 . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Philadelphia, PA June 13-14 . . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Louisville, KY June 20-21 . . . . . . . . . OTS Implant EZ . . . . . . . . . . . . . . . . . . . . .Omaha, NE June 20-21 . . . . . . . . . OTS Implant EZ – Level II . . . . . . . . . . . . .Sun Prairie, WI

Occlusion: Understand simple occlusion procedures for the everyday dentist. Learn to utilize the latest occlusion tools and other resources to ensure a successful prognosis.

March 14-15 . . . . . . . . Every Day Occlusion I . . . . . . . . . . . . . . . . .Sun Prairie, WIApril 25-26 . . . . . . . . . Every Day Occlusion II . . . . . . . . . . . . . . . . .Sun Prairie, WI

March 14-15 . . . . . . . . Full Arch Reconstruction . . . . . . . . . . . . . . .Sandy, UTMarch 28-29. . . . . . . . Clinical Hands On Prepping Session . . . . .Denver, COApril 4-5 . . . . . . . . . . . Full Arch Reconstruction . . . . . . . . . . . . . . .Sandy, UT May 9-10 . . . . . . . . . . Clinical Hands On Bonding Session . . . . . .Denver, COMay 16-17 . . . . . . . . . . Full Arch Reconstruction . . . . . . . . . . . . . . .Sandy, UT

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I’ve had a long-standing relationship with a remarkable Israeli dentist by the name of Martin Stern. Late last year, we had the occasion to meet at the Greater New York Dental Meeting and renew our friendship. We talked about how our relationship had been one of mutual benefit. Martin immediately wrote the following letter that he has allowed us to publish.

—Dick Barnesk

I have an implant practice. I do implants—all day, every day—in Jerusalem, Israel. And if I can keep up this vigorous, daily pace in Israel, then I know you can do a few each week no matter where you are.

In Israel, there are ten times as many doctors per capita doing implants as there are in the United States, and yet my acceptance rate on patient case presentations is—give or take—100 percent. That’s right, about 100 percent. And much of the credit goes to Miriam at the front desk. She is a wizard at working out a viable financial plan for most of these patients.

It hasn’t always been this way.

I was never disposed to spending money on myself, but Dick Barnes is the one who helped me change my attitude about money and see that I couldn’t do all I wanted to help the world by treating more patients if I didn’t have it. He and his programs encouraged me to start practicing cosmetic dentistry to help the thousands of people that wanted and needed beautiful, functional teeth.

Because of my experience with Dr. Dick Barnes, I now have an awesome office—digital radiography, half a dozen lasers, phisiodispensers, and so on. The equipment has quickly paid for itself because of the amount of treat-ment time it saves. It’s Dick’s fault—he inspired me to do

it. With proper equipment and preparation, an implant is a ten-minute appointment in our office. Full arch extrac-tions, implants, posts, and provisionals take under an hour. An implant takes three minutes. Because of lasers, there are no flaps, no cutting, and no suturing. And with digital impressions, the patient can walk out with a permanent crown in under an hour. It is this way that I am able to help so many get the smiles they have always wanted. It’s Dick’s fault—he inspired me do it!

The clincher is the new patient visit: just seven minutes to present full mouth rehabilitation. This, of course, is also because of Dr. Dick Barnes’ tutelage.

It all started with the five slides of patient case presen-tation I learned from Dr. Dick Barnes. These sequential slides help patients see the value in their treatment plan and eventually turned my general practice into a recon-struction practice with such a great need for implants that I had to refer work to 85 outside dentists and six to seven in-house!

But, over time I became distracted by new technology and drifted away from the five magic slides. After several years, I flew to Chicago for one day of the American Academy of Implant Dentistry meeting. It was worth every minute. I skipped the technical stuff and attended a couple of courses and reacquainted myself with Dick. After 20 years, I realized that his presentation was as rich in content and correct in philosophy as ever. I realized that nothing worked magic like Dick’s slides, so when I went back to work I put the slides on the plasma screen in the new patient room and blew them away. They blew me away!

I’ve been around the world and learned dental tech-niques from some of the great dentists—Christensen, Pankey, Miles, Jameson—they all gave me so much. I enjoy what I do and I do it with a passion and love every minute of it. And to whom can I be more indebted than any other, but Dick. His genius is in his simplicity and this genius became a catalyst for a unique blend called me. Thank you, Dick. I love you for all you’ve given me. I’ve devoted my life to passing it on to others and have great satisfac-tion to have been granted the gift of God to do such—with your help.

We were granted the opportunity to provide much for so many, changing the lives of others dramatically

E D I T O R ’ S C O m m E N T A R Y

Proper equipment, attitude, and five essential slides are necessary to provide life-changing care to more patients.

The five sequential slides help patients see the value in their treatment plan and

eventually turned my general practice into a reconstruction practice.

By Martin Stern, D.D.S. and Dr. Dick Barnes

Dick made me Do It

6 Aesthetic Dentistry n Winter 2008

Page 7: Implant Dentistry Thrives Outside the Big City Same Office

As editor, I had trouble placing a self-serving piece of writing in Aesthetic Dentistry, but at the same time it’s a good teaching tool for those of you who wonder whether or not the principles you’ve been taught work in real dentistry.

As we begin a new year, we look forward to providing content that offers more than just fluff. It seems appropriate to reflect on the journal’s health, review new features insti-tuted over the past several months, and mention develop-ments on the horizon.

Like good clinicians, we begin by measuring our vital signs. Aesthetic Dentistry is in excellent health. Dentists are reading in record numbers. The publication now circu-lates annually to 100,000 clinicians throughout the United States, Canada, and Europe. Readers can electronically gain access to the full text of the published articles online at www.arrowheaddental.com in a PDF format.

Readers may have noticed several new features that Aesthetic Dentistry instituted in 2007. We have created an advisory board that helps maintain a high level of quality content. We now send nearly all the submitted articles for external peer review, increasing their educational value. We have established a full spread article highlighting the focus

of the issue. In the Fall 2007 issue Dr. James Downs’ article, “Increase Your Energy & Improve Your Practice,” under-scores the importance of keeping focus on vital principles to maintain a successful dental practice. This main article received a tremendous amount of positive feedback.

In the future, we would like readers to be able to post comments online within one or two days of reading articles and react to what others say about our published articles. In all, we are committed to providing our readers an excel-lent source of information to the latest in technology and

trends in the field of aesthetic dentistry. We thank each of you for your confidence and support.

As ever,

Keeping Focused on Vital Principles

and efficiently. We must maximize this opportunity. It’s an opportunity to stop and smell the roses. Jerusalem—like Sandy or Provo, Utah, Brooklyn, or Los Angeles—is made up of human beings. They are God’s children—whether Jewish or Muslim, Christian or Ottoman. They are mothers and children, grandmothers and grandchildren with needs, wants, and hearts and souls more alike than not.

The opportunity to serve man and god is universal and can really get lost on Eyewitness News. Mrs. Klirn is like

Mrs. Jones; Mrs. Schwartz is like Mrs. Mohammed; they each seek comfort, function, health, and esthetics. Yanky and Moishey, Abdul and Feisel, Bob and Jennifer seek to look good, feel good, and be done with necessary care.

We were granted the opportunity to provide this care and change lives dramatically for so many that it behooves us to maximize our opportunity. We are fortunate to have been exposed to a master who has showed us how to do it faster, easier, and better than ever before! n

We now send nearly all the submitted articles for external peer review, increasing their educational value.

Aesthetic Dentistry n Winter 2008 7

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EditorialDirector DickBarnes,D.D.S.

ManagingEditor DebiEvans

SeniorEditor LindsayHepworth

CopyEditor JulieBillings

CreativeDirector ClarkCollett

MarketingDirector ScottHenkel,C.D.T.

TawanaColemanFortSmith,Arkansas

JamesDowns,D.M.D.Denver,Colorado

CarolGalliano,D.D.S.BatonRouge,Louisiana

TimFreeman,D.D.S.Flagstaff,Arizona

PhillipDurden,D.M.D.Winterville,Georgia

MatthewBuckley,B.D.S.Naas,Ireland

JohnBauer,D.D.S.Mansfield,Texas

FrankHoffmann,D.D.S.Hamburg,Germany

NimmiHolstein,D.D.S.Charlottenlund,Denmark

JoeHufanda,D.D.S.Charlotte,NorthCarolina

JonJulian,D.D.S.McPherson,Kansas

SamCress,D.D.S.SugarLand,Texas

BlairLosee,D.M.D.Lehi,Utah

JoeWillardsen,D.D.S.LasVegas,Nevada

LarryWheeler,D.D.S.Tucson,Arizona

SchuylerVanDyke,D.M.D.GreatFalls,Montana

PatriciaTakacs,D.M.D.Lexington,Kentucky

ChrisStevens,D.D.S.SunPrairie,Wisconsin

BuzzNabers,D.D.S.Knoxville,Tennessee

ChristianYaste,D.D.S.Charlotte,NorthCarolina

PaulaWagner,D.D.S.Jackson,Wyoming

RobertKneib,D.M.D.Erie,Pennsylvania

JoshWagner,D.D.S.Jackson,Wyoming

Publisher HowardCollett

CustomPublishing CentennialPublishing,Inc.OREM,UTAH

Printing RRDonnelley&SonsCHICAGO,ILLINOIS

ForInformation DebiEvansSALTLAKECITY,UTAH

[email protected]

advisory boardA E S T H E T I C D E N T I S T RY E D I TO R I A L

MartinStern,D.D.S.Jerusalem,Israel

STA

FF

8 Aesthetic Dentistry n Winter 2008

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The idea of placing and restoring seemingly complex implant devices never entered my mind until about five years ago. It was then that I met an instructor who intro-duced me to implant dentistry. I had always thought my patients were different from those in larger communities and that implants were just too progressive for my rural area. Wow, was I wrong!

My uninformed attitude toward implant dentistry was, in hindsight, due to my lack of knowledge on the subject. People in my small community had the need for implants and desired them just as much as anyone. I just needed to be educated on what implants were and why my patients would want them in their mouths.

I started pursuing education that would teach me to place and restore implants in my own office. I soon found

myself exaggeratedly talking to every patient about the missing teeth in their mouths. My staff became infected by my excitement, and my practice started seeing benefits immediately. When people understand the advantages of an implant instead of an empty space or bridge, choosing an implant becomes easy. At a minimum, we as practitio-ners should become informed about implants so we can offer our patients a complete range of options.

Following my training, one of my first implant cases was for a patient who has been visiting my practice for years. He presented with a failing implant in the upper left central position. An oral surgeon had placed the implant six years previously. There was localized gingival swelling and noticeable color change to the tissue. I exposed the area to see what was causing the problem.

The first picture in my discovery process shows the exposed failing implant (fig. 1). Notice the total facial bone loss over the existing implant. I removed the implant using a trephine burr kit and then curetted the site and sterilized the area with a DEKA CO2 laser. After sterilization, I placed small particle Puros Bone Grafting Material. I then placed a Resolute Adapt barrier membrane over the bone graft and sutured the overlying tissue together with 6.0 PGA suture. I then left it to heal for six months. (Normally I would have

continued on page 12

Fig. 2 - ANKYLOS A11 implant placement.

Fig. 1 - Exposed, failing implant with total facial bone loss.

I m P L A N T E Z n S C H u Y L E R V A N D Y K E , D . m . D .

Implant Dentistry Thrives Outside the Big City

As a small town dentist in montana, I never imagined implant dentistry would grow to be such an important aspect of my practice.

I had always thought my patients were different from those in larger communities

and that implants were just too progressive for my rural area. Wow, was I wrong!

10 Aesthetic Dentistry n Winter 2008

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Page 12: Implant Dentistry Thrives Outside the Big City Same Office

waited only four months before placing the implant, but the patient’s schedule was uncooperative.)

Figure 2 shows the implant placement. I selected an ANKYLOS A11 implant for the number 9 missing tooth site. I followed the ANKYLOS placement protocol for surgical preparation of the implant osteotomy. I made an incision slightly to the lingual of the number 9 site using the CO2 DEKA laser. I then reflected this tissue slightly to the facial and lingual to not only check the graft healing, but to visual-ize the ridge, as well.

I used a pilot drill to initiate the implant location and orientation. I drilled very cautiously so as not to encroach on the facial plate of bone. I then used a Tri-Spade drill to a depth of approximately 13 mm so that the final implant placement would be approximately 2 mm below the crestal height of interproximal bone. I used the A-11 Conical Reamer in the hand wrench to further prepare the site and confirm the depth. Subsequently, I placed an ANKYLOS A 11mm implant in the prepared site with ensuing excellent primary stability and verified the implant level.

Next, I removed the cover screw with a helical reverse threaded removal instrument and placed an ANKYLOS impression pin. I took an impression for the lab to fabricate a temporary crown. I then placed a Balance Sulcus Former with a gingival height of 3 mm to allow a gingival collar to form while the lab fabricated the temporary crown.

Three weeks later, I placed a Radica temporary implant crown from Arrowhead Lab on the abutment. We also performed a gingivectomy on tooth number 8 to bring symmetry to the gingival margins of number 8 and 9. By placing the temporary crown early, the papilla could start gaining its natural form prior to the permanent crown place-ment in approximately four months. This temporary was taken out of occlusion for the four month healing period.

We placed an anterior flipper in the interim while waiting for the lab to complete the temporary crown.

The final picture (fig. 3) shows the seated temporary crown in place. The best part was that the patient was thrilled to have this done in my office instead of having to go back to the oral surgeon, and he was delighted to get rid of the temporary flipper he had been wearing since the grafting procedure. There are so many cases just like this one waiting to be done in every practice. It is such a rewarding feeling to place and restore them yourself.

My office now averages approximately 100 implants per year. To provide the best possible treatment for my patients, I continue to pursue additional training. I can’t say enough about how implants have positively impacted my practice. I’m a more confidant practitioner and am certainly providing a great service to my patients. Learning to place implants has truly made me a better dentist. If you have thought about learning to place implants, but are hesitant, please remember my story and get started. n

Schuyler VanDyke, D.M.D., attended Oregon Health Science University School of Dentistry. She has been practicing for 18 years. She started Sunset Dental Care in Conrad, Montana in 1993. Her practice provides orthodontics, implants, cosmetic and family dentistry. She is a member of the ADA, MDA, ICOI, AAID, AO, and DOC.

Fig. 3 - Seated temporary crown in place.

VANDYKE - continued from page 10

Learning to place implants has truly made me a better dentist.

12 Aesthetic Dentistry n Winter 2008

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Page 14: Implant Dentistry Thrives Outside the Big City Same Office

Presenting Value

Page 15: Implant Dentistry Thrives Outside the Big City Same Office

L A B P E R S P E C T I V E n H E R N Á N A . V A R A S , m . B . A .

For quite some time I have postponed the painful task of buying a new car.

The experience of purchasing such an expensive item is not something most people enjoy; especially when we know that our final decision will be influ-enced by somebody else’s knowledge and persuasion ability. I wanted to purchase a high quality, dependable car that was at least as nice as the cars my children drive. After speaking with several friends and coworkers, I found myself in a Mercedes Benz dealership.

I was warmly greeted by a salesperson whose enthu-siasm was contagious. He convinced me that Mercedes manufactures the greatest cars ever built.

Within a few minutes, he knew exactly what I wanted and presented me with benefits that far exceeded the sticker price. He sold me on the value of a Mercedes. I was eager and happy to sign the purchase agreement. I was even happier when I drove my new baby home. I thought, “I wish I had done this a long time ago.”

We all make financial sacrifices to get what we want, particularly

when we see value in them. This principle is no different in

dentistry, where there are three levels of value.

Presenting Value

Page 16: Implant Dentistry Thrives Outside the Big City Same Office

Much like my car buying experience, patients accept treatment and make financial sacrifices when they under-stand the value that treatment will have in their lives. In his lectures, Dr. Dick Barnes states that patients go to the dentist because they trust their dentist’s skill, care, and judgment to help them with their decisions—much like I relied on the Mercedes dealer’s knowledge to make a good decision. Dr. Barnes also emphasizes the importance of being technically and clinically prepared so that when the patient accepts treatment, you can confidently deliver

a great restoration. Presenting comprehensive dentistry carries the responsibility of being fully prepared to follow through with your and the patient’s expectations.

What patients wantPatients want what modern dentists can provide. They

don’t want technical details; they just want to know that they will have a beautiful smile. That is where the value lies. Comparing it to my car experience, I did not care about the technical details or how the car was made. I only cared that it drove beautifully and that I felt great driving it.

It is our mission at Arrowhead Dental Laboratory to help dentists increase the value of their practices by provid-ing high quality restorations using state-of-the-art materials and techniques, along with superior technical support and service. Our technical support team is fully prepared to assist dentists in determining the best possible materials, techniques, and procedures for all their cases—from a simple single unit to a full arch restoration.

One of the ways Arrowhead assists dentists is by offering three levels of aesthetic techniques: Classic, Bella, and Elite. These techniques can be applied to any porce-lain system in order to suit each patient’s unique aesthetic needs and expectations.

use lab for product selectionDentists with practices that emphasize cosmetics and

full mouth rehabilitation understand how fundamental it is to utilize their lab for product selection prior to and through-out treatment. Factors considered include age, skin tone, previous restorations, shade, eye shape/position, lip line, dark post/core, etc. There are so many different products, procedures, and techniques a dentist can use for a resto-ration that the decision can be overwhelming. Arrowhead provides a resource to help dentists wade through that variety.

Today, patients are very demanding when it involves smile makeovers. They don’t care about how their teeth are made; they care about how they will look. They see value in having a beautiful, natural looking smile. Quoting Dr. Barnes, “Patients no longer want nice caps; they want beautiful teeth.” Nice caps are totally unacceptable today.

Arrowhead’s three levels of aesthetic techniques give dentists the flexibility to select the perfect restoration for each individual patient. The ultimate goal is to deliver value

to the patient so when treatment is completed, they can say, “I wish I would have done this a long time ago.” n

Hernán A. Varas, M.B.A., is the Professional and Clinical Develop-ment Executive at Arrowhead Dental Laboratory.

Patients go to the dentist because they trust their dentist’s skill, care, and judgment to

help them with their decisions.

16 Aesthetic Dentistry n Winter 2008

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European dentists are faced with an ever-increasing demand from patients to make their teeth and face look younger, more vibrant, and more aesthetically beautiful. Their collective desire is to travel up the ladder of self-esteem so they can get better paying jobs and appear better in social settings. To them, however, beautiful teeth without a beautiful frame do not make a complete beautiful smile.

To meet this demand, cosmetic dentists in Europe are qualifying themselves in non-surgical facial aesthetics, such as the use of Botulinum toxin and dermal fillers.

Botulinum toxin is marketed under brand names like Dysport and Botox. The purified toxin, a polypeptide, prevents acytylcholine release in the synapse between the nerve ends and the muscle fibers, creating a temporary relaxation of the carefully targeted muscle. After three to four months, the toxin protein molecule is safely and completely removed from the body by phagocytosis and excreted by the liver.

The dental applications of Botox include not only the conjunctive treatment of Trismus (lockjaw), Masseter hypertrophy, teeth clenching, TMD, muscle spasms, Sialor-rhea, non-surgical lip lowering on a gummy smile, reducing Cheilitis on mouth angles, but also the popular treatment of headaches, migraines, and neuralgias by reducing muscular trigger-points—often in conjunction with bite guards. Most patients, however, don’t mind the side effects of losing their frown lines and facial wrinkles.1

Like it has been in Europe, the next step in dentistry in the United States may well be to begin creating a beautiful frame for the actual dental masterpiece.

In addition to Botox treatments, in Europe we have seen that dermal fillers are also useful in dento-facial aesthetics, especially non-permanent fillers like hyaloronic

acid, a polysaccharide naturally found in skin. Such fillers are marketed both in Europe and the United States under the brand name Restylane.

A beautiful smile makeover no longer needs to suffer the injustice of being framed by thin lips. For genetic reasons or just time and aging, the face and lips lose collagen and become thinner and more wrinkled with what are commonly called “smoker’s lines” or “lipstick bleeder lines.”

Either in conjunction with raising a bite and seating a full arch case or just an anterior smile case, trained dentists in Europe are augmenting lips, nasolabial folds, and other rhytides with Restylane to soften wrinkles and define or plump up lips to give them more volume, more youth, and more radiance. This underlines the fact that lips and teeth are an inseparable whole, but also raises the question of whether dentists are encroaching on the turf of plastic surgeons.

It appears, however, that the emerging field of dento-facial and non-surgical aesthetics lies within the domain of modern dentistry. Dentists are trained at the level of specialists in facial anatomy and the function of mastica-tory muscles. Dentists have become experts in the art of injecting dermal fillers, earning the right to learn the liquid face lift.

Whether or not you agree, the field has emerged and it is here to stay. Increasing numbers of dentists in Europe are taking courses in the dental uses of Botulinum toxin and dermal fillers, perhaps also prompted by the incitement that the revenues it brings in can supersede what they make on dentistry alone. n

Dr. Nimmi Holstein is President of the European Society of Dento-Facial Aesthetics. He leads courses in botulinum toxin and dermal fillers for doctors and dentists.

1~ Once a drug has a US FDA approval it can legally be used for other treatments like dental applications. Such use is called off-label use. Several muscle injection points for headache treatment coincide with the same points for wrinkle softening.

Future dental patients may not be content with just a beautiful smile; they’ll want a beautiful face to go with it.

S C I E N C E & T E C H N O L O G Y n N I m m I H O L S T E I N , D . D . S .

Dento-facial Aesthetics: A New Paradigm in Dentistry

A beautiful smile makeover no longer needs to suffer the injustice of being framed by thin lips.

18 Aesthetic Dentistry n Winter 2008

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Many Aesthetic Dentistry readers are avid followers of the Dr. Dick Barnes Group and are familiar with the general structure taught by its highly trained and continually educated staff of actively practicing professionals. Several years ago, Dr. Barnes developed a unique set of detailed operation and organizational systems, which, when imple-mented properly and continuously, can transform an average dental practice into a mega-producing superstar. Dr. Barnes has the uncanny ability to put this process into a

cohesive sequence of events, that when followed, produce predictable success and profitability.

Total team trainingLess than three years ago, we met the incredible

Tawana Coleman at a Total Team Training seminar and our lives and practice were forever changed. For the last twenty-five years, we have operated a one-dentist practice in a small Texas town, never producing or collecting anywhere near $100,000 a month. Now, after diligently working to properly implement the structure on the way to becoming “Barnesified,” our office averages in excess of $250,000 a month. We have the same doctor, the same staff, the same facility, but a new structure.

This structural transition was not easy. But change is never easy, and early success helps confidence and desire soar. With his system, Dr. Barnes has the innate ability to clear the extraneous and reinforce the positive to ensure continual motivation. In addition, the structure is based on common sense principles that we already understood and

could apply. The key difference is the unique implementa-tion and presentation by which Dr. Barnes relays these principles.

System sequenceLike any other successful program, there is a specific

sequence and wording necessary for each segment of each system comprising the structure. To maximize the potential of the Dr. Barnes structure, implementation must be in strict accordance with the sequence and wording set forth by the system. While it may be exacting in nature, every time we have seen a dip in production or case acceptance, we have been able to right the proverbial ship without anxiety, fear, or practice overhaul by simply returning to the basics of the structure and adhering to the sequence of the system.

In spite of the proven success of the Dr. Barnes system, some dental offices continue to come up with excuses of why it will not work for them. Every participant in the dental office—doctor, staff, and patients—are all

continued on page 22

Detailed operation and organizational systems can transform an average dental practice into a mega-producing superstar.

I N S I G H T S n T E R R I B A u E R , R . D . H .

Every time we have seen a dip in production or case acceptance, we have been able to

right the proverbial ship by simply returning to the basics of the structure and adhering to

the sequence of the system.

Same Office, Newer System, Better Profits

20 Aesthetic Dentistry n Winter 2008

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Page 22: Implant Dentistry Thrives Outside the Big City Same Office

members of the same group: the human race. Geographic location, economy, or insurance dependency does not make a measurable difference. Attitude, adaptability, and desire are all you need to experience true success in your dental practice.

Office cultureSuccess does come with a price: our office worked

very hard in three areas to incorpo-rate the Dr. Barnes structure into the culture of our practice.

Build relationships. From the initial phone call to the new patient interview to the actual presenta-tion of treatment, there are many opportunities to build a special relationship with the patient. This is critical in building trust in any relationship, but is most important to the doctor-patient relationship. People only continue a business relationship with those they like and trust.

Present comprehensive dentistry. Everyone in the office must look past insurance benefits, apparent financial status, and any other barrier to acceptance and be able to effectively present comprehensive dentistry to each and every patient.

Become educated. The dentist must be competent and trained to do aesthetic and implant dentistry, as well as understand the role occlusion plays in these areas.

As daunting as this process may sound, the Dr. Dick Barnes Group has created a complete and simple system to help dental practices make the transition to success and profitability. Dr. Barnes has assembled top clinicians in Total Team Training, cosmetic dentistry, implant dentistry, and neuromuscular occlusion with the ability to train dentists and their staffs. Our office took advantage of these oppor-tunities, made a commitment to the Dr. Barnes structure, and has since become proficient in each identified area. This has resulted in professional satisfaction and profit.

If we can do this in the small community of Mansfield, Texas, I am confident that it can be done anywhere. n

Terri Bauer, R.D.H., runs all practice management, business management, and treatment coordination for Mansfield Family Dentistry. She has been in the dental industry for 27 years. As a member of the Dr. Dick Barnes Group, Terri assists Tawana Cole-man with Total Team Training.

BAUER - continued from page 20

Attitude, adaptability, and true desire to serve people are all you need to experience

true success in your dental practice.

22 Aesthetic Dentistry n Winter 2008

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Page 24: Implant Dentistry Thrives Outside the Big City Same Office

The adage “friends do business with friends” is really true.

We most often choose to obtain products and services from those with whom we feel some sort of connection. The stronger the connection, the stronger the loyalty. So how is it possible to create strong relationships with hundreds if not thousands of patients? Is it even possible? Absolutely. Just ask Oprah!

Millions of people—mostly women—feel that Oprah is a best friend, even part of the family. What’s the secret? What makes you feel loyal to someone you are never or rarely with? Communication! She talks to them. She talks to them every day about something relevant in their lives.

I’m not suggesting that to create loyal patients you need to have a top-rated TV show. But the more you speak to your patients in a personal and relevant way, the more loyal your relationship grows.

The loyalty ladderIn the book Relationship Marketing, Regis McKenna

describes the loyalty ladder. The loyalty ladder is comprised of segments ranging from suspects—those who have heard your name or seen your advertisement—all the way

up to advocates. At the top of the ladder, these advocates are not only fully committed to you as their dentist, but they will also insist that everyone they know use you as well.

Moving your patients up the loyalty ladder is relatively simple. First you have to provide a quality service or experi-ence. We’ll assume that is the case. Second, you need to establish constant and relevant communication with them in a personal way.

Communication evolutionThe dental industry is in the middle of a communica-

tion evolution. We are rapidly leaving the time when we can reach patients through the mail or hope to catch them on

the phone. We are entering the era of reaching patients on mobile devices wherever they are. It’s time to start thinking about how to reach patients where they are—not where they were. The American Board of Physicians says, “85 percent of patients say that electronic communication would be a good way to communicate with his/her doctor.” SMS, or cell phone text messaging, is rapidly becoming the de facto standard for instant communication.

How many personal communications, outside your office, do your patients receive from you? You certainly are not going to be able to speak personally or write to each of them enough times to turn them into advocates without

help. Technology is the solution. A good patient relationship management (PRM) system can help you communicate with your patients in a personal and relevant way, as often as you like – in a very economical manner.

Start thinking about how to reach patients where they are—not where they were.

H O T P R O D u C T S n m A R K O L S O N

Communication and Loyalty

continued on page 26

Fig. 1 - The Smile Reminder system includes automated and personalized appointment reminders.

24 Aesthetic Dentistry n Winter 2008

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Reminder service

Jim Higgins, CEO of Smile Reminder—the premier dental PRM system—talks about the success some clients see when they use his Smile Reminder service. “We have practices that have created incredibly loyal patient bases,” he said. “The doctors that really understand the potential reward constantly communicate with their patients. They not only remind and market, but they also educate their patients about conditions, treatment options, products and services—even local news and events. They stay in touch with their patients and their patients stay loyal to their dentists.”

According to Higgins, one benchmark of a loyal patient base is the volume of referrals a doctor receives. “The Smile Reminder system tracks referrals and referral value,” said Higgins. “We clearly see a direct correlation between the level of communication with patients and the volume and value of referrals back to the doctor.”

Patient surveysPatient surveys are another great way to improve

communication and build your relationships. You cannot know what patients want and care about if you don’t ask.

People love to express their opinion and give feed-back—especially if they think their ideas will make a differ-ence. In addition to questions about your office, your staff,

and your service, ask about what kinds of educational information patients find helpful. When their opinions are valued and they see response to their suggestions, your patients will become more invested in your relationship and your practice because they have played an active part in improving it.

Dr. Ron Kaminer (Long Island, New York) talks about his experience using the Smile Reminder Service. “I was overwhelmed by the reaction of my patients when I started using Smile Reminder,” he said. “My patients love the increased communication! I get comments all the time about the personal text message they get from me on their

birthday. Surveys and newsletters have also been fantastic. I use them to understand my patients better and to educate on what matters most to them. When patients come to the office with a prior understanding of conditions such as caries and oral cancer, they are more accepting of my examinations and treatment planning.”

Appointment remindersThe Smile Reminder system includes automated and

personalized appointment reminders, last minute cancella-tion notices, premed reminders, birthday messages, and value tracking recall/recare messages. It also includes custom newsletters, personalized marketing messages, and value tracking referral tools. All messages are person-alized to each patient and maintain the practice’s brand and identity. Relevant and personal communication can be sent across your entire practice or just to a target group of patients. No upload of patient information is necessary because the system will seamlessly interface with your existing PMS and obtain all the appointment and contact information needed.

You may never achieve Oprah status with your patients, but you certainly can improve your relationships and push them further up the loyalty ladder. The tools and technology are available; now you need to make yourself available. n

A graduate of the Marriott School of Management at Brigham Young University, Mark has 20 years marketing experience ranging from small start-ups to billion dollar companies. With particular focus on consumer marketing, his experience includes time with Marriott Corporation, Sundance Resort, Park City Reservations, Simmons Media Group, Ticketmaster/CitySearch, Iomega Corporation, and Communitect Inc., parent company of Smile Reminder.

Fig. 3 - Patient surveys improve communication and build doctor-patient relationships.

OLSON - continued from page 24

Fig. 2 - All messages are personalized to each patient and maintain the practice’s brand and identity.

Relevant and personal communication can be sent across your entire practice or just to a

target group of patients.

26 Aesthetic Dentistry n Winter 2008

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