Articulator Volume 23, Issue 2 by Metro Denver Dental Society

ARTICULATOR MDDS Connections for Metro Denverâ&#x20AC;&#x2122;s Dental Profession

10 Gen-Blending Creating Generation "US"

4th Quarter, 2018 Volume 23, Issue 2

EDITION

16 Peri-Implantits. Incidence, 26 Prevalence and Treatment

5 Social Media Challenges and How to Overcome Them

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4th quarter 2018

what's inside?

10 Gen-Blending Creating Generation "US"

pg.12

12 Dream Big 16 Peri-Implantits. Incidence, Prevalence and Treatment

20 All Ceramic Considerations 22 Freedom Day 2018 T:10”

24 Immunization Recommendations for Oral Health Professionals

26 5 Social Media Challenges and How to Overcome Them

Advertisers Directory

ADS Precise Transitions adsprecise.com................................. 21 Berkley Risk Services of Colorado colorado.berkleyrisk.com...................... 5 Best Card bestcardteam.com............................... 4

Dente Vita Prosthodontics dentevita.com................................... 27

Carr Healthcare Realty carrhr.com........................... Back Cover

New Horizons Dental Lab http://denturesonimplants.com............. 6

Colorado Dental Association cdaonline.org.................................... 25

Northwestern Mutual shawncopeland.nm.com.................... 21

Commerce Bank commercebank.com/dentistry....Inside Front Cover Copic Financial Services Group copicfsg.com..................................... 15

departments

Dentists Professional Liability Trust of Colorado tdplt.com.......................................... 13

CTC Associates ctc-associates.com/............................ 19

Peak Dental Services peakdentalservices.com..................... 14 Peebles Prosthetics, Inc. www.peeblesdentallab.com................ 28 SAS Transitions sastransitions.com............................... 5

4 Chair’s Message 6 Reflections 7 Member Spotlight 8 Member Matters 15 Nonprofit News 28 Tripartite News 30 Event Calendar 31 Classifieds

Co-Editors Amisha Singh, DDS; Allen Vean, DMD Creative Manager CT Nelson Director of Marketing & Communications & Managing Editor Cara Stan MDDS Standing Officers President Brian Gurinsky, DDS, MS President-Elect Nelle Barr, DMD Treasurer Kevin Patterson, DDS, MD Secretary Pat Prendergast, DDS

Editorial Policy All statements of opinion and of supposed factare published under the authority of the authors, including editorials, letters and book reviews. They are not to be accepted as the views and/or opinions of the MDDS. The Articulator encourages letters to the editor, but reserves the right to edit and publish under the discretion of the editor. Advertising Policy MDDS reserves the right, in its sole discretion,to accept or reject advertising in its publications for any reasons including, but not limited to, materials which are offensive, defamatory or contrary to the best interests of MDDS. Advertiser represents and warrants the advertising is original; it does not infringe the copyright, trademark, service mark or proprietary rights of any other person; it does not invade the privacy rights of any person; and it is free from any libel, libelous or defamatory material. Advertiser agrees to indemnify and hold MDDS harmless from and against any breach of this warranty as well as any damages, expenses or costs (including attorney’s fees) arising from any claims of third parties.

Inquiries may be addressed to: Metropolitan Denver Dental Society 925 Lincoln Street, Unit B The Articulator is published quarterly by the Metropolitan Denver Dental Denver, CO 80203 Society and distributed to MDDS members as a direct benefit of membership. Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com ©2018 Metropolitan Denver Dental Society Printing Dilley Printing

Member Publication

RMDC 2019

RMDC Chair's Message By Charles Danna, DDS

am honored to serve as Chair of the 2019 Rocky Mountain Dental Convention. I have seen a lot of changes since I first attended the Denver Midwinter Dental Convention (now RMDC) in 1977. That event

was held at Currigan Exhibition Hall, just a stone’s

throw from the present Colorado Convention Center. The vendors featured various displays mostly on dental treatment and equipment. I do not remember seeing practice management groups or advertising companies. At that time, advertising for your dental practice was limited to three lines in the yellow pages of the local phone book. The newest technology was light-cured restorations and new porcelains for restorative restorations. The Midwinter speakers were few, but well selected, and there were not many courses for team members.

your practice to help make it more productive and enjoyable. I encourage you to kick-off your RMDC experience at Thursday’s Opening Session. One of our most popular speakers, Dr. Uche Odiatu, will motivate everyone in the crowd to improve their physical condition to handle the demands of work and a busy personal life. Be sure to arrive at 8:00am for Dr. Odiatu’s energetic presentation.

"At the 2019 RMDC you will see several companies that can market, finance and help your practice succeed, and even assist with job opportunities."

even assist with job opportunities. Technology will abound from implants and CBCT imaging to radiology and 3D printing. Knowledgeable representatives will be on hand to answer questions and demo new product features. All of this – and more – can be found in the Expo Hall, along with The Summit: CE & Demo Stage. The Summit will showcase quick, one-hour CE sessions on topics like dental operating microscopes, immunization recommendations, reputation marketing and early childhood caries.

attendees have in downtown Denver. The 2019 RMDC has plenty of fun social events in store. The Friday Night Party at the Hyatt Regency Denver is free to attend and the first 500 guests receive two free drink tickets so arrive early! The MDDS Awards Gala & President’s Dinner celebrates MDDS President Dr. Brian Gurinsky and honors MDDS members for their outstanding service to the Society. I hope you can join

In contrast, at the 2019 RMDC you will see several companies that can market, finance and help your practice succeed, and

A favorite aspect of the RMDC is the great time

us for this social event. Dr. Gurinsky is from Dallas, so for some Texas-style fun, head up to the Expo Hall on Friday and ride RMDC Russell, the mechanical bull. Try and survive an 8-second ride! I am sure everyone will have a fun and rewarding experience at this year’s convention. A big thank you to all the volunteers and staff who have worked hard to make this event possible. I look forward to seeing you in January. Sincerely, Charles Danna, DDS

The 2019 educational program covers a wide array of topics for every member of the dental team. Clinical staff can attend courses on pharmacology, laser dentistry, TMD, periodontology, endodontics and pediatric dentistry. Office managers and front office personnel can learn about insurance coding, eliminating cancelled appointments and

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4th Quarter 2018 mddsdentist.com

REFLECTIONS

Challenges By Allen Vean, DMD

s I write this year-end reflection, we are approaching the mid-term elections. The results will be determined well after this Articulator is published. One thing is certain, health care coverage in our country is a hot topic. From a historical aspect, our profession has been the leader in healthcare. We should be quite proud of the fact that we have always been a preventivefocused discipline as opposed to other medical counterparts who approach their patients from a reactive view. Patients seen on a routine basis have less dental disease and treatment is less expensive to complete. Despite this, many patients avoid dental care due to fear – including fear of cost or no third-party coverage. How do we provide care for uninsured patients (nearly 50% of the population) who are retiring from the workforce, losing their dental benefits, dormant patients or see no need for our services? This is a complex issue. We can look into our past to provide a "One thing is certain, solution for the future.

health care coverage in our country is a hot topic. From a historical aspect, our profession has been the leader in healthcare."

Many readers will remember when third-party dental coverage was first introduced. As with all new programs, it was met with some fear and trepidation. How is this going to affect the dentist-patient relationship that we covet so dearly? Is treatment going to be dictated by these companies that have the bottom line as their priority instead of patient welfare? Over the years, different forms of third-party coverage have appeared on the market. The traditional indemnity plans have survived with certain caveats including networks of providers that must adhere to the companies’ policies. Dentists must make a monumental decision on how these coverages are going to be either integrated or not into their practice. When “capitation plans” were introduced into the dental market, a dentist was reimbursed a monthly amount per patient. In return, they performed certain procedures at no charge or a nominal co-pay. If a patient needed additional treatment, it was provided at a contracted rate with additional co-payments. The practice was reimbursed this “cap fee” whether the patient visited the office or not, so it was to the dentist’s advantage that patients not seek further treatment. Some of these plans still exist today in the form of a PPO, HMO, etc. However, as practitioners, we generally like to be in control of our patient’s treatment and the management of our practices. As I stated previously, the doctor-patient relationship should not have any interferences. Is there a way that we can control this? One idea comes from the July 9, 2018 issue of ADA News. Dr. Greg Yen, a Seattle-based second-generation dentist, offers an in-office membership plan to his patients. The basics of the plan consists of an annual membership fee that includes most preventive services and discounts on

4th Quarter 2018 mddsdentist.com

others services. The third-party carrier is eliminated in this model. There is no interference in the dentist-patient relationship. The patient knows exactly what the treatment plan will entail in addition to the cost. Today, we are discussing going back to our roots and maintaining the sacred doctorpatient relationship, but with a new twist that allows the dentist to be in control. History repeating itself? How ironic. In-office plans can be designed in a multitude of ways that can be advantageous to both the dentist and patient. The ADA has vast resources for members on this topic. The toolkit is available at Success.ADA.org/en/dental-benefits/. Each practice must decide the most appropriate plan for their situation, if they decide to make a transformation. In-office plans are one model – among many – that may be useful. Fear of change is one of our unique characteristics. How we manage that fear is the ultimate test. We are certainly able to manage our patient’s fears on a regular basis. My deepest thanks to all for supporting our publication. I wish everyone a healthy, happy holiday season and New Year. We hope to see you at RMDC.

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MEMBER SPOTLIGHT Brian Butler, DDS, MS Prosthodontist BridgeCreek Prosthetic Dentistry Denver, CO What is your favorite part about your job?

"I enjoy the patient treatment and interaction with the team concept of working with other colleagues to treat patients. Dentistry is changing constantly with new technology and concepts to further enhance our ability to treat patients and keeping up with the changes provides for continued excitement."

What made you decide to become involved with the RMDC planning?

"I have always been involved in giving back to dentistry and I feel being involved in our local and national societies is important. Meetings like RMDC offer us an opportunity to not only get together to advance our education, but also allow colleagues to visit and collaborate. I like having a part in providing a strong educational opportunity and securing top speakers for a great convention. "

What are you most looking forward to about this yearâ&#x20AC;&#x2122;s convention??

"I always look forward to all the great speakers we have and the opportunity to catch up and visit with colleagues. It is always an honor to be able to speak at the meeting as well."

What advice would you give a first time attendee??

"Take advantage of everything you can at the meeting: the great speakers, exhibit hall and vendors, and the social events to connect with area dentists and your team. I encourage everyone to bring your staff and make it a fun event for all to enjoy and use the meeting for team building."

How long have you been speaking? And, what influenced you to make the transition from attendee to speaker?

"I began speaking in residency and have been speaking for 15 years. My residency program required us to present to other colleagues and provided me with the opportunity to become a better speaker. I really enjoyed this because it made me a better clinician and I liked teaching others. I continue to speak to be involved in education, travel and meet dentists with similar passions in dentistry."

What would you be doing if you were not in dentistry?

"If I were not a dentist, I would try to find something I could do that would involve working in the outdoors preferably with hunting, fishing or outdoor adventures. It could also involve an opportunity in the travel industry allowing me to travel around the world."

2nd 4th Quarter 2018 mddsdentist.com

MEMBER MEMBERMATTERS MATTERS

MDDS All-Committee Summit

New Members, Welcome! Dr. Andrew Baek Dr. Dustin Bailey Dr. Justin Becerra Dr. Anurag Bhargava Dr. David Bryant Dr. Nicholas Byars Dr. Nathaniel Cejka Dr. Taylor Francis Dr. Matthew Goergen Dr. Allison Gorab Dr. Martha Ha Dr. Bryan Habet

MDDS leadership and volunteers gathered at the Thirsty Lion in Cherry Creek for dinner, drinks and networking. This thank-you event allowed the Society to express its gratitude for volunteers.

MDDS Student Mingle

Dr. Melissa Hernandez Dr. Patrick Hoblitzell Dr. Brian Hudec Dr. Conrad Johnson Dr. Roy Kaluzshner Dr. Ashish Kunnekel Dr. Brett Lopez Dr. Carol Luong Dr. Kristopher Mendoza Dr. Tram Nguyen Dr. William Paini Dr. Ines Quintanilla Dr. Joseph Ramos Dr. Stephen Rogers Dr. Krupa Soni Dr. Mark Stasi Dr. David Sugiyama Dr. Daniel Thousand Dr. Gary Tong Dr. Lindsay Towler Dr. Bo Tran Dr. Brandon Visscher Dr. Supneet Wadhwa

3rd and 4th year as well as ISP dental students from the University of Colorado School of Dental Medicine gathered at Cheluna Brewing in the Stanley Marketplace for the annual MDDS Student Mingle. Students enjoyed a taco bar, drinks and spoke with current MDDS members about what to expect from life after dental school.

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Dr. Kathleen Waguespack Dr. Ramsey Warner

Dental Line 9

MDDS and CDA volunteer dentists answered call-in oral health questions from the public on channel 9 news’s Dental Line 9.

New Member Welcome Event – Public School 303

MDDS members enjoyed time to kick-back and connect with colleagues at the MDDS’s quarterly New Member Welcome Event at Public School 303 downtown.

Colorado Mission of Mercy (COMOM)

Volunteer dentists and team members from around the state teamed up to provide free oral health care to 1,100 patients over two days in Greeley, CO.

4th Quarter 2018 mddsdentist.com

RMDC SPEAKER

Gen-Blending Creating Generation "US" By Cindy Ishimoto

egardless of where you practice, you likely have

5. Loyalty – not a function of age but a function of position in the

employees from three generations working

organization; the higher your position, the more time you work

alongside each other: Baby Boomers, Gen Xers and Millennials. Generation Z is beginning to enter the employee ranks which will now place

6. We All Want to Learn – people want to do a good job and are willing to acquire new skills in order to do so

four generations in dental offices. They all bring their

own strengths and weaknesses to the practice, along with work philosophies and priorities. It’s important to realize that each generation has its own

7. Everyone Likes Feedback – we all want to know how we are doing

comparatively

unique characteristics and style of communicating not just with one another, but with other generations. The so-called “generation gap” is, in large part,

The goal of effective communication is: clear message sent, clear message

the result of miscommunication and misunderstanding fueled by common

received. We must find common ground by understanding everyone’s

insecurities and the desire for influence and power.

communication needs and then we’ll have a much better chance of building valuable relationships that impact the bottom line.

If you take the time to understand each generation and develop solid management strategies, you’ll put together a cohesive team that’s prepared to

The following are a snapshot of strategies for communicating with Baby

care for patients at the highest level and help the practice succeed. The goal is

Boomers, Generation X, Millennials and the youngest in the workforce, Gen Z.

to create Generation “us.” Communicating with a Baby Boomer All generations are similar in the following areas: 1. Value Structure – the values that matter most, i.e. family, integrity,

Baby Boomers, born between 1946 and 1964, have experienced many

honesty, trustworthiness

changes during their careers. These changes have made them quite flexible in their thinking, which is what they expect of those they interact with. If an issue at your practice needs to be resolved, don’t just present one solution;

2. Wanting Respect – even with slightly different definitions, we all still

want to be heard and valued for our contribution 3. Trustworthy Leaders – without trust, relationships falter, communication stops and productivity is lost

have three. Boomers like to see flexibility in your thinking and want details to prove that you thought everything through. Baby boomers are known to be workaholics, desire high quality in their products and services and aren’t afraid to question authority. They want to be interconnected leaders, so working with them as a team member is relevant

4. Nobody Likes Change –stereotypes say Millennials love change

and valuable.

but research has shown the opposite: no one generation is more or less comfortable than the other

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Boomers prefer face-to-face conversations and to be shown how to do

things. They like to know that their contribution is needed and recognized

formal. They seek a fun, interactive work environment and believe there is a

with a reward, which may include a meaningful title. If time is limited for an

life outside of dentistry.

in-person discussion, consider video tutorials for this "show me" generation. Keep in mind that these communication needs are also required by your Boomer patients.

Communicating with Generation Z Born after 1996, Generation Z has always been surrounded by all the latest and greatest technologies. However, they do crave some face-to-

Communicating with Generation X

face communication. Although social media and other technologies help

Gen X’ers, born between 1965 and 1980, want structure and direction and

feed their need for visuals, face-to-face communication fills their need for

are often skeptical of the status quo. They are more adept with technology

authenticity.

than their predecessors. This generation is juggling many things in their current stage of life, so e-mail works well for them as a communication tool.

Also, because they grew up with Gen X parents who often worked full-

Time may not allow for face-to-face conversations. It’s always important to

time or switched careers more than once, these individuals understand the

make sure they feel valued and that their voice is heard. Because X’ers view

importance of staying relevant by continuing to learn and proving themselves

everyone as being the same, feel free to challenge them and communicate

in the workplace. Being the youngest generation in the workforce, this Gen

directly. Gen X'ers are more likely to express an opinion without being asked

Z is well aware that they have a lot to learn and can benefit from mentoring.

and they prefer to be asked in person for their assistance and input. Having a conversation and following up with an X’er immediately after an event is more relevant than waiting too long. They like hearing feedback, so give it freely. Keep in mind that autonomy is important to them, so inspect what you expect. Provide them with regular feedback and remember that they prefer e-mails and inperson conversations to be short and to the point.

"It’s important to realize that each generation has its own unique characteristics and style of communicating not just with one another, but with other generations."

While they might opt to text or e-mail, this generation is very adaptable to other generations’ communication preferences - as long as they are learning. They understand the value of face-to-face conversations but need to be taught how to have these conversations due to their workplace immaturity. Whatever the case may be in terms of shifting career and communication needs, determining and communicating guidelines and expectations up front is critical. A specific

Communicating with Generation Y (Millennials) Generation Y, born between 1981 to 1996 also known as Millennials, were practically born with smartphones in their hands and grew up using computers. This group is in a stage where they are always trying to prove themselves to older generations. They appreciate being challenged but will resent anyone who talks down to them. They desire to be treated like an equal in the workplace, not as a child. As a generation, they want to be recognized in the workplace for their areas of responsibility. The best approach for communicating with Generations Y and Z is to speak with these employees daily, provide training on how to operate in the practice and note that they crave one-on-one assessment and feedback. Millennials are always wondering about what is next. They are entrepreneurial, goal-oriented and desire their work to be meaningful and feel comfortable with multitasking; feel free to create participative conversations. To work well with this group, be prepared to explain your thinking – they will not hesitate to question you if you don’t. Millennials are also future focused. They want to know what you see for their future and what opportunities are available to them to move up. This group is not known for its patience, so don’t be surprised when they ask for a promotion six months into a job; manage expectations early. Generation Y prefers e-mail communication and texting, but don’t be too

example is that many Boomer bosses may be expecting more hours from employees while the Millennial team member and Generation Z are looking forward to a flexible schedule that allows time to attend family functions. You need solid systems, job descriptions and measurements to properly manage these generational perspectives and needs. With a minimum of four generations in your office, you can be sure you’ll encounter plenty of miscommunications and misunderstandings. As a leader, it is your job to wade through the distractions, improve your verbal and non-verbal communication skills and focus on establishing clear communications in order to build trust. The good news is that many commonalities exist among the generations and their attitudes toward work. Working is a means for personal fulfillment, not just a paycheck, and workplace culture is important to every generation. Therefore, leaders must work to foster and develop a positive workplace environment so employees can openly and honestly communicate. About the Author Ms. Cindy Ishimoto has 35 years of speaking experience and dental consulting in all types of practices. She is well known for her expertise in the business, financial management, motivational and team building systems of the practice. She has been named a Consulting Leader by Dentistry Today from 2006-2018.

4th Quarter 2018 mddsdentist.com

RMDC SPEAKER

By Carrie Mauterer, DDS

and lock in an ideal partner to secure our next phase of growth. few years ago, I was taking a walk with my youngest son and we started chatting about Christmas. I asked In the year since we partnered with our Dental Service Organization him if he knew what he was going to ask Santa to bring (DSO), we have seen a dramatic increase in our practice growth. Sure, him. His answer still makes me chuckle to this day. He before making this move I learned how to run a fairly solid business. I responded with his typical deadpan face, “A swimming pool learned how to calculate city use tax (uhh…after our first audit happened). with a basketball court on top.” Wowzah! That is definitely dreaming big. I learned what a water tap is and that ours would cost $85,000 (after the While I tiptoed my way around the obvious problem (that the overhead building loan was already tapped out). I even went to basketball court is going to mess up Shamu’s triple classes on increasing our Google juice (why does it flip), I gently pointed out that a swimming pool with have to be juicy?…blech). However, by handing over a basketball court on top may not fit into Santa’s "My business partner our finances to a CFO, our equipment and supply sleigh. I suggested that if he wanted it bad enough, and I realized that to accounts to a CEO with actual buying power, and our he should find a way to finance it himself. Although marketing to a Millennial with an advanced marketing he was lacking an MBA and was just five years old, take our practice to our his answer was as confident as Warren Buffet’s would dream level, it was time to degree, our practice achieved our big dreams much faster and easier than going it alone. be. He responded, “That’s OK Mom. I’ll just raise the join forces with a strong money by selling rocks from our driveway.” That’s Consolidating our practice with a new partner was a my Sully - he’s not afraid to dream big. company with bigger long uncharted journey. With DSO companies rapidly resources." changing the industry, there was no guidebook to I share my son’s penchant for big dreams and creative instruct us on our next steps. So, we wrote our own solutions. I have huge dreams for my career and my book. group practice I share with my business partner. I may not be awesome at selling rocks, but I am pretty good at taking care Please join me as I share my story of the journey of finding a DSO of my patients. I absolutely love it. The honor of earning our patient’s trust partnership and what life is like on the other side. As you curl up with your and watching their families grow is the best thing in the world about being hot cocoa at The Summit: CE & Demo Stage (BYOHotCocoa) with me on a dentist. Not surprisingly, being a dentist is what I do best with my dental Friday morning, I will share my insights, successes, fears and ridiculous degree. Conversely, being a small business owner was just a means to an flubs and blunders on my journey to chase my big dreams. After all, aren’t end. The tasks involved with practice ownership were not my favorite and our personal stories what bring us all together? not something my dental degree prepared me for. As our practice scaled up from a scratch start practice in a space sharing environment all the way to 12-operatories, we saw many successes each year. I found that eventually my big dreams outgrew our individual resources. My business partner and I realized that to take our practice to our dream level, it was time to join forces with a strong company with bigger resources. As I enter my fourteenth year and the fourth growth phase of my dental career, I have seen rapid changes in the dental industry. I have enough experience to know that we had to stay ahead of the curve

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About the Author Carrie Mauterer, DDS, owned her private general dentistry practice for 13 years before partnering with Peak Dental Services in 2017. She currently serves the Colorado Dental Association (CDA) as Vice President and the American College of Dentists Colorado as Secretary. She and her husband, Jason, have 5 boys, 13 chickens, 2 golden retrievers and 1 angry cat. She is a terrible gardener and knitter, but a pretty darn good whistler.

Take a Closer Look

.00

New Graduate 1st Year Rate

All malpractice policies are not created the same

There are a lot of diﬀerences between being a Member of the Trust and just another policy number at a large, commercial carrier. Both give you a policy the Practice Law requires, but that’s where the similarity ends. Consider… Who do I talk to when I have a patient event, claim or question? The Trust: Local dentists who understand your practice, your business and your needs. Them: Claims call center (likely in another state).

Do I have personal input and access to the company? The Trust: Yes. You are represented by dentists from your CDA Component Society giving you direct, personal access to the Trust. Them: Yes, via their national board.

How much surplus has been returned to dentists in Colorado? The Trust: Over $1.8M has been distributed back to Colorado dentists as a “return of surplus” (after all, it’s your Trust, your money). Them: $0

Besides a policy, what do I get when I buy coverage? The Trust: Personal risk mitigation training, educational programs and an on-call team that “speak dentist.” Them: Online support.

Do I have to give my “Consent to Settle” a case? The Trust: All settlements are based on the best interests of the dentist, patient and Trust Members. Them: Read the ﬁne print; ask about their “Hammer Clause.”

How many years has the company been serving Colorado dentists? The Trust: 29 years. Established by dentists in 1987. Them: It’s hard to say... they tend to come and go.

Protect your practice. Call the Trust today. Dr. Randy Kluender · 303-357-2602 Dr. H. Candace DeLapp · 303-257-2604 1st Quarter 2018 I mddsdentist.com www.tdplt.com

Don’t Miss This Special Presentation! Transitioning from Private Practice Owner to Partnering with a DSO

Are you attending the 2019 Rocky Mountain Dental Convention at the Colorado Convention Center? Don’t miss Dr. Carrie Mauterer’s presentation, “Transitioning from Private Practice Owner to Partnering with a DSO” on Friday, January 18, 2019 from 10:00 -11:00 AM in the Expo Hall in The Summit room (session code: 1290).

For more information, please call or email us at peak@peakdentalservices.com or visit our website at www.peakdentalservices.com “The support that Peak has given to me and my practice has lifted the weight of the world off of my shoulders. I’m a happier doc at work because I can focus more time on my patient care and I’m a happier mom and wife at home because my stress is so minimal. I wish I had found Peak 10 years ago!” – Dr. Carrie Mauterer, Appletree Dental

FRIDAY JANUARY 18 • 10:00 - 11:00 AM EXPO HALL/THE SUMMIT ROOM • SESSION CODE: 1290

NONPROFIT NEWS

AN UPDATE FROM COLORADO ASDA’S COMMUNITY OUTREACH TEAM

he University of Colorado School of Dental Medicine’s ASDA community outreach efforts began approximately four years ago when the Colorado chapter of ASDA expanded its presence on campus and in the community. The majority of our group’s work is directed towards oral health education for elementary and middle school aged children as well as their parents. Dental students active on this committee have worked together to create a variety of funny and informative skits, games, craft activities and assessments for children we work with. As of 2018, we have also started working with the Boys and Girls Club and providing geriatric-focused oral health education to a local assisted living community residents and caregivers. Our chapter has also set a goal for next Spring to reach out to underserved and/or young mothers-to-be, counseling them on prenatal and infant oral health.

Through our outreach chairs and student volunteers we are proud to have representation on the MDDS Community Outreach & PR committee as well as a team of volunteers at the Kids in Need of Dentistry (KIND) Gala each year. The outreach team has also recently connected with Dental Lifeline Network (DLN) to participate in their community collaboration ideas and efforts. Our goal as a community outreach team is to provide CU dental students with more volunteer opportunities in hopes to create community-oriented and conscientious graduates. We look forward to working with all of you!

4th Quarter 2018 mddsdentist.com

RMDC SPEAKER

PERI-IMPLANTITIS. Incidence, Prevalence and Treatment

By Michael Norton BDS, FDS, RCS(Ed)

t is estimated that only 2 -3% of the edentulous population has received dental implants. In the United States, approximately 500,000 implants are placed each year compared to the United Kingdom where that figure was estimated at 140,000 in 2010. The prevalence of periimplantitis has been reported to be up to 29%1 most notably in patients whose implants are placed within a partial dentition. This yields a potential incidence with possibly 185,000 implants in the US and UK that might succumb to some form of peri-implant disease on an annual basis. The bacteria found within peri-implant lesions are similar to those found in deeper periodontal pockets2,3 and cross infection by periodontopathogens as a primary aetiology has been implicated as a possible pathway. The wide variety of implant designs, surfaces and prosthetic restorations, etc. make the treatment of peri-implantitis much less predictable than periodontal disease. In 2008, a systematic review4 of the literature regarding peri-implantitis using PubMed and the Cochrane Library revealed little consensus on the treatment of this troublesome condition. One study reported on the efficacy of sub-mucosal debridement using ultrasonics or carbon fibre curettes5, while two others compared the effect of an Er:YAG laser against that of mechanical debridement and 2% chlorhexidine as a combined therapy 6, 7 . The first found similar results between laser and combined therapies, while the second concluded that the laser effect was limited to a six month period. A further study compared combinations of oral hygiene instruction, mechanical debridement and topical minocycline with a similar regime which substituted 1% chlorhexidine as the antimicrobial8. The former seemed to confer some benefit while the latter showed limited or no clinical improvements. Finally, a study comparing two bone regeneration procedures reported clinically significant improvements mediated by both9. Nonetheless, a multitude of other studies have also been published reporting on the efficacy of tetracycline10, CO2 laser11 and photocatalytic decontamination amongst others in the treatment of peri-implantitis12. Such a variety of therapies make it difficult for the clinician to choose a regimen that is both within the reach and has documented reliability.

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Risk Factors There are a number of risk factors cited for peri-implantitis. In a study published in the Journal of Clinical Periodontology, a clear association was demonstrated through multi-level statistical analysis between risk of peri-implantitis and location, specifically the maxilla. Overt peri-implantitis was shown to be highly correlated to male patients with a predisposing history of periodontitis13. Surprisingly, in this particular study no correlation was demonstrated with smoking; yet this has been a consistently cited risk factor in many other studies. In a study published in the Swedish Dental Journal in 2010, the percentage of implants with peri-implantitis was significantly increased for smokers compared to non-smokers (p = 0.04)14. Other factors include excess cement, poor oral hygiene and prosthesis design. These are inter-related with some prostheses making effective oral hygiene untenable, while others present deep margins that make removal of excess cement almost impossible.

Warning Signs Peri-implantitis rarely presents unannounced unless the patient fails to be placed on a regular recall program or fails to attend regular reviews. Early signs are often apparent in the form of peri-implant mucositis. This condition is characterised by mucosal oedema, rubor and bleeding on probing (BOP). The condition is not associated with bone loss15, is often asymptomatic to the patient and only diagnosed at routine recall. There is a need to recognise that when implant treatment is completed, the patient should remain on annual reviews for at least five years, and thereafter once every two years. On presentation with mucositis or early peri-implantitis with limited bony involvement, a combination of mechanical debridement and sub-mucosal decontamination and antimicrobial therapy are indicated. There are many different recommended regimens, but the author favours a so-called â&#x20AC;&#x2DC;Triple Therapyâ&#x20AC;&#x2122; which has been used with great success. The treatment should be repeated three times within a two-week period and consists of the following

Protocol 1. Sub-mucosal irrigation with HybenX (Epien Medical Inc, USA) oral tissue desiccant at the deepest level of the pocket on all sides of the implant for 10 seconds immediately followed by

2. Sub-mucosal irrigation with 5-10mL chlorhexidine (0.2%) (Corsodyl, Omega Pharma Manufacturing GmbH, Germany) per site, at the deepest level of the pocket on all sides of the implant. 3. Application of Minocycline Gel 2% (Dentomycin, Henry Schein Ltd, UK) at the deepest level of the pocket on all sides of the implant. Once peri-implant mucositis has taken hold, it is often exacerbated by the current design of implants. The presence of a rough surface taken to the top of an implant and the application of micro-threads or grooves are potential confounding factors for the advance of the lesion due to biofilm formation and bacterial contamination of the surface. lead to bone loss and further surface exposure. Advancing bone loss often results in colonization of the deeper pockets with well known periodontopathogens and infection ensues. This is peri-implantitis.

Peri-implantitis Peri-implantitis is characterised by the presence of vertical or crater-like bone defects and spontaneous purulence and bleeding on palpation (Fig 1& 2). It is typically associated with deep peri-implant pocketing > 5mm. This condition is undoubtedly of increasing concern due to the following principle factors: • Almost exclusive use of roughened implant surfaces.

Fig 1

Fig 2

• Treatment of partially dentate patients with a history of periodontal disease. • Placement of implants with inadequate bone volume resulting in facial dehiscences. • Use of cement retained prostheses. Implants with a micro-roughened surface texture have presented excellent long-term data and until recently, there has been very little published in the literature demonstrating a susceptibility of these surfaces to this condition. A recent work by Albouy et al16, 17 has received widespread attention with concern for the evidence that suggests some modern micro-textured surfaces may be completely resistant to decontamination17. Such implants are unlikely to respond successfully to any treatment and their removal is inevitable. Ultimately, if left unchecked and untreated, it may become impossible to arrest the condition, leading to failure of the case (Figs 3 & 4). Such failures impose a tremendous strain and burden on the clinician (let alone the patient), destroying the confidence of a patient who has endured significant expense and trauma. This occasionally results in a breakdown of communication between both parties that sadly, all too often, results in a legal claim of negligence. Such claims can be hard to defend for patients where no warnings and/or supportive periodontal/peri-implant therapy have been undertaken. These radiographs demonstrate multiple advance crater-like defects, which are associated clinically with profuse purulence.

Fig 3

Fig 4

4th Quarter 2018 mddsdentist.com

Treatment typically requires surgical access to excise any fibrous capsule and for direct access to the implant for surface decontamination. The author’s preference until now has been to use chlorhexidine and tetracycline solution for this purpose while others have reported the use of citric acid and hydrogen peroxide amongst others17. The use of lasers has also been extensively reported6,7,19-21. However, in a recent systematic review, a meta-analysis could only be done for the Erbium YAG laser as the literature on all other laser types was weak or heterogenous22. The author recently completed a prospective closed-cohort study of 20 patients in an efficacy trial using ErbiumYAG water laser (Morita, AdvErl Evo, Kyoto, Japan) and the results of this study showed great promise with notable resolution of both defect depth as well as percentage suppuration and BOP23. Promising data has been published using this same machine24, 25. Nonetheless, this methodology remains outside the reach of most general practitioners and has yet to be proven reproducibly effective. Most attention remains focused on physical debridement via surgical intervention and topical antimicrobial therapies. Open flap debridement, defect decontamination and repair as well as pocket elimination have all become the mainstay of those treating this condition. Is there a crisis? The problem is there is no clear consensus on the prevalence of the disease since this will vary according to the cut off values for the clinical parameters measured26 and to date there appears to have been little consensus of these cut off values. For example, what is the appropriate cut-off value for pocket depth that should signify disease? Is it as with the periodontium, that a >4mm pocket represents the onset of such disease? Does spot bleeding on probing represent disease? Or are these indices not relevant to the peri-implant environment? There is much to be debated. Estimates of prevalence of the disease appear to vary from 28% to 56% of subjects and 12% to 43% of implant sites27. Furthermore, there is an ongoing controversy about the initiating process of peri-implant disease since it is potentially considered a primary infection of periodontopathic origin by some28 while others hold that it is a secondary opportunistic infection subsequent to bone loss caused by other etiological factors28,29 such as a provoked foreign body reaction or iatrogenic dehiscence of the bone, exogenous irritants such as dental cement, bone loss through occlusal overload etc. If the latter is true then controlling the disease is made simpler by controlling the conditions for the implant, such as ensuring adequate buccal bone thickness, avoiding or controlling more carefully the use of dental cement and paying closer attention to the occlusion. In an effort to gauge the rate of mucositis and peri-implantitis requiring surgical intervention, the author audited his patient pool in the year 2014. Out of a total of 191 patient reviews constituting 795 implants, only 15 patients (7.9%) required triple therapy at 20 implants (2.5%) for mucositis while 10 patients (5.2%) required surgical decontamination at 10 implants (1.3%). These are well below the figures proposed for prevalence in the article by Zitzmann & Berglundh (2005)15. This may reflect a more liberal approach to cut off values for parameters such as pocket depth and bleeding on probing as proposed by Klinge in 2012 26. Nonetheless, after over 25 years running a practice dedicated to implant dentistry, the author’s own audited failure rates indicate that less than 0.5% of implants present as late failures due to peri-implantitis or fixture fracture as a result of bone loss. This would corroborate the findings by Jemt et al in which a cohort of patients already diagnosed with peri-implant bone loss showed a slow rate of additional progressive bone loss over a nine-year follow-up with an implant failure rate of less than 3% 29. In all likelihood, peri-implantitis will only become an epidemic crisis if we continue to allow bad implant dentistry to persist where there is a lack of control of the initiating factors described above. The author believes, that for the majority,

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it is more likely that peri-implant inflammation is the result of a secondary opportunistic infection rather than a direct susceptibility to primary infection of periodontopathic origin. This is in stark contrast to the views of the periodontal community, who in 2017 published their findings of the 2017 World Workshop on peri-implant diseases and conditions30 in which they continue to state that periimplantitis is a plaque-associated pathological condition, where there is limited evidence for non-plaque associated disease. This would appear to run contrary to the views of many performing implant treatments day-to-day in clinical practice. That is not to say that there will clearly be some patients with a high genetic susceptibility to biofilm induced disease with other predisposing factors such as the presence of untreated periodontal disease, smoking and diabetes who may well succumb as a result of primary infection. As such, there remains a clear need to better define the different types of aetiology predisposing peri-implant disease as highlighted in a recent article by Sarmiento et al 31, since different aetiologies of the disease may result in a pathology that responds differently to different therapies applied. For example, in cement-induced peri-implantitis, removal of the cement excess is all that may be required to ensure a successful resolution of the disease; but, this does not apply for screw-retained structures that present with a similar pathology but different aetiology. Finally, there is an urgent need to establish a consensus as to the cut off values for the different parameters used to evaluate the disease so that future figures for incidence and prevalence are comparable. About the Author Dr. Michael R. Norton BDS FDS RCS(Ed) graduated from the University of Wales in 1988. He is a specialist in Oral Surgery and Fellow of the Royal College of Surgeons, Edinburgh. Michael is Adjunct Clinical Professor at the University of Pennsylvania Dental School. References 1. Kalykakis GK, Mojon P, Nisengard R, Spiekermann H, Zafiropoulis G-G. Clinical and microbial findings on osseointegrated implants – Comparisons between partially dentate and edentulous subjects. Eur J Prosthodontics and Rest Dent 1998; 6: 155-159. 2. Karoussis I, Müller S, Salvi G, Heitz-Mayfield L, Brägger U, Lang N. Association between periodontal and peri-implant conditions – A 10-year prospective study. Clin Oral Impl Res 2004; 15: 1-7. 3. Gatti C, Gatti F, Chiapasco M, Esposito M. Outcome of dental implants in partially edentulous patients with and without history of periodontitis – A 5-year interim analysis of a cohort study. Eur J Oral Implantology 2008; 1: 45-51. 4. Kostovilis S, Karoussis I, Trianti M, Fourmousis I. Therapy of peri-implantitis – A systematic review. J Clin Periodontol 2008; 35: 621-629. 5. Karring ES, Stavropoulos A, Ellegaard B, Karring T. Treatment of peri-implantitis by the Vector system. Clin Oral Impl Res 2005; 16: 288-293. 6. Schwarz F, Sculean A, Berakdar M, Georg T, Reich E, Becker J. Clinical evaluation of an Er-YAG laser combined with scaling and root planning for non-surgical periodontal treatment. A controlled, prospective clinical study. J Clin Periodontol 2003; 30: 26-34. 7. Schwarz F, Sculean A, Rothamel D, Schwenzer K, Georg T, Becker J. Clinical evaluation of an Er-YAG laser for non-surgical treatment of perimplantitis: a pilot study. Clin Oral Impl Res 2005; 16: 44-52. 8. Renvert S, Lessem J, Dahlén G, Renvert H, Lindahl C. Mechanical and repeated antimicrobial therapy using a local drug delivery system in the treatment of peri-implantitis: a randomized clinical trial. J Periodontol 2008; 79: 836-844. 9. Roos-Janker A-M, Renvert H, Lindahl C, Renvert S. Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane – A prospective cohort study. J Clin Periodontol 2007; 34: 625-632. 10. Mombelli A, Feloutzis A, Brägger U, Lang N. Treatment of peri-implantitis by local delivery of tetracycline – Clinical, microbiological and radiological results. Clin Oral Impl Res 2001; 12: 287-294. 11. Romanos G, Nentwig G. Regenerative therapy of deep peri-implant infrabony defects after CO2 laser implant surface decontamination. Int J Periodont & Rest Dent 2008; 28: 245-255. 12. Suketa N, Sawase T, Kitaura H, Naito M, Baba K, Nakayama K, Wennerberg A, Atsuta M. An antibacterial surface on dental implants, based on the photocatalytic bactericidal effect. Clin Impl Dent Rel Res 2005; 7: 105-111. 13. Koldsland OC, Scheie AA, Aass AM. The association between selected risk indicators and severity of peri-implantitis using mixed model analysis. J Clin Periodontol 2011; 38: 285-292. 14. Carcuac O, Jansson L. Peri-implantitis in a specialist clinic of Periodontology. Clinical features and risk indicators. Swed Dent J 2010; 34: 53-61 15. Zitzmann NU, Berglundh T. Definition and prevalence of peri-implant disease. J Clin Periodontol 2008;35(8 suppl):286-291. 16. Albouy JP, Abrahamsson I, Persson LG, Berglundh T. Spontaneous progression of peri-implantitis at different types of implants. An experimental study in dogs. I: Clinical and radiographic observations. Clin Oral Implants Res 2008; 19: 997-1002 17. Albouy JP, Abrahamsson I, Persson LG, Berglundh T. Implant surface characteristics influence the outcome of treatment of peri-implantitis: an experimental study in dogs. J Clin Periodontol 2011; 38: 58-64. 18. Gosau M, Hahnel S, Schwarz F, Gerlach T, Resichert TE, Bürgers R. Effect of six different peri-implantitis disinfection methods on in vivo human oral biofilm. Clin Oral Impl Res 2010;21:866-872. 19. Deppe H, Greim H, Brill T, Wagenpfeil S. Titanium deposition after peri-implant care with carbon dioxide laser. Int J Oral & Maxillofac Implants 2002; 17: 707-714. 20. Walsh LJ. The current status of laser applications in dentistry. Aust Dent J 2003; 48: 146-155. 21. Bach G, Neckel C, Mall C, Krekeler G. Conventional versus laser-assisted therapy of peri-implantitis – A five-year comparative study. Implant Dentistry 2000; 9: 236-246. 22. Kotsakis GA, Konstantinidis I, Karoussis I, Ma X, Chu H. A systematic review and meta-analysis of the effect of wavelengths in the treatment of peri-implantitis. J Periodontol 2014;85:1203-1213. 23. Norton MR. A One-Year Prospective Closed Cohort Study on the Efficacy of ErYag Laser in the Decontamination of Peri-implant Disease. Int J Periodont & Rest Dent 2017;37:781-788. 24. Yamamoto A, Tanabe T. Treatment of peri-implantitis around TiUnite-surface implants using ErYAG laser microexplosions. Int J Periodontics Restorative Dent 2013;33:21-30. 25. Nevins M, Nevins ML, Yamamoto A, Yoshino T, Wang C-W, Kim D. Use of Er:YAG laser to decontaminate infected dental implant surface in preparation for re-establishment of bone-to-implant contact. Int J Periodontics Restorative Dent 2014;34:461-466. 26. Klinge B. Peri-implant marginal bone loss: An academic controversy or a clinical challenge. Eur J Oral Implantol 2012; (5 Suppl);13-19. 27. Romeo E, Ghisolfi M, Carmagnola D. Peri-implant diseases. A systematic review of the literature. Minerva Stomatol 2001;53:215-230. 28. Albrektsson T, Dahlin C, Jemt T, Sennerby L, Turri A, Wennerberg A. Is marginal bone loss around oral implants the result of a provoked foreign body reaction? Clin Implant Dent Rel Res 2014;16:155-165. 29. Jemt T, Sundén Pikner S, Gröndahl K. Changes of Marginal Bone Level in Patients with "Progressive Bone Loss" at Brånemark System® Implants: A Radiographic Follow-Up Study over an Average of 9 Years. Clin Implant Dent Rel Res 2015;17:619-28. 30. Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, Chen S, Cochran D, Derks J, Figuero E, Hämmerle CHF, HeitzMayfield LJA, Huynh-Ba G, Iacono V, Koo KT, Lambert F, McCauley L, Quirynen M, Renvert S, Salvi GE, Schwarz F, Tarnow D, Tomasi C, Wang HL, Zitzmann N. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1 31. Sarmiento H, Norton M, Fiorellini, J. Development of a Classification System for Periimplant Diseases and Conditions. Int J Periodont & Rest Dent. 2016; 36: 699 - 705.

SELLING your DENTAL PRACTICE? Appraisals • Practice Sales • Partnerships • Buyer Representation • Post-Transition Coaching Start-Up Coaching • Associateships

Your Dental Practice Is Your Legacy.

Larry Chatterley

Marie Chatterley

Randon Jensen

As dental practice transition specialists, we guide you through the complex process of selling your practice to ensure everything goes smoothly with the legacy you have built.

Operating since 1988.

Complimentary Consultation

303-795-8800 See what our clients say about our services: “Amazing group of people! Our transition couldn't have been as smooth as it was without CTC associates. They really took the time to help explain everything in detail and make sure that we understood what we needed to do during the transition. Couldn't ask for a better team to work with. Thank you CTC associates!” - Dr. Nathan Schmidt

“I sold my practice to my associate and Larry and his team were wonderful to work with. They handled the endless details beautifully and made the transition a really easy one for all of us. I highly recommend them and am so thankful they were there to guide us though the process!” - Dr. Naomi Jacobs

“If you are in need of a practice broker, I would highly recommend CTC to get the job done. The entire process could not have been more streamlined and stress free... CTC is an A+ operation and I would highly recommend them to anybody who is looking for someone to assist them in selling what I consider to be your biggest investment. Thank you again Larry!” - Glenn Thompson, D.M.D.

“I have worked with Larry since 2006, when I bought my dental practice. Everything went great with that transaction and I have seen him as a valuable asset ever since. I can always rely on Larry for an honest and practical approach to business decisions that I have consulted him on. I always know Larry has my best interest in mind over just closing a deal... I highly recommend Larry.” - Dr. Tim Owens

info@ctc-associates.com

www.ctc-associates.com 6105 S Main Street, #200, Aurora, CO 80016 (303) 795-8800 | marie@ctc-associates.com | larry@ctc-associates.com

RMDC SPEAKER

ALL CERAMIC CONSIDERATIONS By David Ruppert

he trend is clear here at Peebles Premier Ceramics: shelf space reserved for the incoming, all-ceramic restorative work is expanding. More and more offices are requesting metal-free crowns and bridges to satisfy the ever-growing public demand for more lifelike restorations.

this because if we have a request for a highly esthetic zirconia restoration over a dark, non-vital prep, oftentimes the dental office believes the zirconia will block the dark prep from coming through. Unfortunately, this blocking capability is no longer universal to all zirconia materials. Modern multilayer zirconia can be as translucent as lithium disilicate.

The bottom line is this: if an all-ceramic restoration is prescribed, it is absolutely Technological advances in materials and production methods vital that a stump color is provided to your laboratory. For best results, be sure have made all-ceramic a viable alternative to the tried and true porcelain-fusedto pick the stump color soon after prepping, before the to-metal and full-cast restorations that have been the bedrock stump has had a chance to dehydrate. of fixed restorative dentistry for decades. Whether removed by a dentist or lost due to wear and trauma, these all-ceramic "Technological Your lab technicians and ceramic specialists will restorative materials can be a viable substitute for the lost advances in materials choose the base material for the lithium disilicate or dentin and enamels. This trend shift is not driven by eyeand production zirconia based on the stump shade. You can trust your pleasing results exclusively â&#x20AC;&#x201C; biocompatibility and strength lab ceramicist to choose the materials that will best are key factors as well. methods have made mute or accentuate the shade of the prep to achieve all-ceramic a viable a pleasing final result for the patient. Remember, you All-ceramic esthetic solutions come with an often must give them all the tools required for the job. The overlooked requirement that is critical to the success of the alternative to the tried products available to labs to simulate the color of the all-ceramic application. This requirement entails taking the and true porcelainstump shade are limited in range. Still, technicians will shade of the prepped tooth the restoration is being bonded fused-to-metal and fulluse their expertise to get as close to the provided stump to. As technology advances, we must also advance in how shade as possible to help guide the fabrication of the we utilize it. cast restorations that restoration. have been the bedrock The color transmitted to the surface of the crown from the This is where the dental office and doctor expertise interior stump can influence the final shade of the restoration of fixed restorative come in. To ensure the best shade match, an alldramatically. In any all-ceramic restoration, the interior color dentistry for decades." ceramic restoration should be cemented or bonded of the prep or abutment is a crucial factor in the success of the with an agent that has a range of chroma and opacities. final shade of the restoration. The final shade can be dialed-in with the colored cements and bonding agents to create a beautiful end result. What do you do if your tooth prep does not have favorable coloring, such as a metal post, or a black or dark stump? An all-ceramic restoration may not be Remember, with all-ceramic restorations, translucence is like a two-way street: your best choice for that particular case. The unfavorable value or color can be transmitted to the surface, causing the crown to be low in value or discolored. light goes in and color comes out. Always provide your lab a stump shade. This color transmission and light absorption quality is true with lithium disilicate as well as modern zirconia. About the Author David Ruppert began his career in dental technology 1976. In 1985 thru 2005, The first generations of zirconia used for frameworks and monolithic crowns Dave operated Creative Design Dental Restoration a boutique lab, specialized were very opaque and did block some color transmission to the surface. in custom esthetic crown and bridgework. He joined Peebles Prosthetics in 2013 However, this blocking capability in early zirconia came with a heavy price, as and is the Ceramics supervisor for Peebles Premier Ceramics. Dave has been a far as esthetics were concerned. The high opacity of the material was far too high certified dental technician for 38 years. in value, or light reflectivity, which made it esthetically undesirable. I mention

20 4th Quarter 2018 mddsdentist.com

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Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company, Milwaukee, WI (NM) (life and disability insurance, annuities and life insurance with long-term care benefits) and its subsidiaries. Shawn W Copeland is an Insurance Agent of NM. Registered Representative of Northwestern Mutual Investment Services, LLC (securities), a subsidiary of NM, broker-dealer, registered investment adviser, and member FINRA and SIPC. Representative of Northwestern Mutual Wealth Management Company®, Milwaukee, WI (fiduciary and fee-based financial planning services), a subsidiary of NM and federal savings bank.

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FREEDOM DAY 2018

On Thursday, October 11, nineteen practices around the metro area participated in the nationâ&#x20AC;&#x2122;s largest military thank you event. Each year on Freedom Day USA, businesses across the country open their doors to offer products and services to members of the military, veterans and their immediate families. Examples of services that MDDS member offices offered were oral cancer screenings, hygiene, fillings, basic extractions and more. Thank you to all the practices who participated and we look forward to an even bigger event in 2019!

Freedom Day Participants All About Braces Alpine Dental Center Appletree Dental Barron Family Dental Belmar Park Dental

22 4th Quarter 2018 mddsdentist.com

CBS News films Dr. Eric Van Zytveld and his patient for Freedom Day to help spread the word about this annual charitable event.

Borris Dental at Belmar Brightside Dentistry Bromley Park Dental Denver Restorative Dentistry Eric W. Van Zytveld, DDS Guaranteed Smiles Dentistry

Hill View Dentistry Park Hill Family Dentistry Smile Aurora Dental Taylor Dental Arts West Ranch Dental Center Wynkoop Dental

Dr. Hana Kim poses with a patient and her team at Smile Aurora Dental.

Appletree Dental was able to accommodate 15 patients for Freedom Day. This is Drs. Mauterer and Derbyâ&#x20AC;&#x2122;s 4th year participating.

Dr. Kim performs an oral health exam on a veteran.

Dr. Ian Paisley sees military patients during Bromley Park Dentalâ&#x20AC;&#x2122;s first Freedom Day event.

Dr. Van Zytveld poses with a veteran and Dental Lifeline 4th Quarter 2018 Network patient beforemddsdentist.com his exam.

23 23

RMDC SPEAKER

IMMUNIZATION RECOMMENDATIONS FOR ORAL HEALTH PROFESSIONALS By George Gatseos II, DDS, MSBA

re you at risk for acquiring an occupational

and the health of your patients and staff. Your staff will only get vaccinated

related illnesses? What is your vaccination status

if you are vaccinated, so be sure to set a good example. You should be able to

based on the Centers for Disease Control (CDC)

communicate the benefits of the recommended vaccinations to your staff, patients

Recommended Immunizations for Dental Health

and their parents (in the case of minors) for their health as well as the health of

Care Workers? All dental professionals should know and have

the population at large. A recent report from the Center for Disease Control and

record of the answers to these questions in order to be OSHA compliant and

Prevention estimated 100,000 young children have not been immunized against

maintain a safe work environment.

any of the 14 diseases for which vaccinations are recommended. These numbers were sourced from a telephone survey in 2017 from parents

The top public health achievement of the 20th century has

been

the

development

immunization

prevent communicable diseases. Are you aware of the recommendations by the CDC of the vaccinations to prevent the transmission of occupational communicable disease? By attending Immunization Recommendations for Oral Health Professionals, you will learn and be able to: describe the immunological response process and how

"The benefits are obvious for the protection of your family, staff and patients. We want to prevent acquiring diseases that can be transmitted from occupational exposure."

of approximately 15,000 toddlers. The 100,000 estimate refers to the 2017 vaccination status of kids born between 2015 and 2016. “This is pretty concerning. It’s something we need to understand better and reduce,” said the CDC’s Dr. Amanda Cohn. Young children are especially vulnerable to vaccinepreventable diseases, some of which are fatal. A separate CDC study found that overall vaccination rates for

vaccination recommendations are formulated; list the

older, kindergarten-age children continue to hold steady with

current immunization recommendations issued by the

nearly 95% fully vaccinated.

CDC‘s Advisory Committee on Immunization Practices (ACIP); and explain issues affecting compliance with immunization recommendations and vaccine.

In Greek, the word philotimus means "love of honor." As doctors (and teachers) we should strive to be a philotimo-minded person and protect our patients, ourselves

The benefits are obvious for the protection of your family, staff and patients. We

and the public. Be aware that your behaviors are not only a reflection of yourself,

want to prevent acquiring diseases that can be transmitted from occupational

but also of your family, community and country. Take pride in what you do,

exposure. We cannot afford to lose the services of valuable staff members to

simply because you have taken the time and effort to do it. Help others because

clinical disease transmission acquired from unsafe dental infection control

they need help. Do the right thing because you have a duty to do the right thing.

practices. Consider the liability to you and your staff if you have not had the

As a dental professional, I call on you to take action and take a proactive role in

recommended vaccinations as a healthcare worker and a patient accuses you of

promoting the CDC’s recommendations on vaccinations for you, your staff and

transmitting a disease to them while they were receiving dental treatment in your

your patients. Because Safety Matters!

office? What would be the economic impact to your dental practice if you were disabled for a week or even a month, after acquiring measles, chronic hepatitis or another communicable disease? Could you keep the doors open without hiring for a substitute dentist while you are ill? An important question is, how much do you value your continued health for a lifetime? How much is it worth to not have acquired Hepatitis B? What is the cost to you and your family if you acquire chronic liver disease, liver cirrhosis or possibly need a liver transplant? Vaccinations are a key component in prevention from contracting occupational diseases and help avoid these aforementioned challenges. Healthcare workers only have a 70-90% compliance rate for the recommended Influenza Vaccination. Your risk of acquiring influenza is critical to your health

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About the Author

George G. Gatseos II, DDS, MSBA, is Chief Executive Officer of Safe Dental Services, a Colorado-based dental infection control and practice consulting firm specializing in Occupational Safety and Health Administration training and compliance for dental professionals. An author and lecturer, Dr. Gatseos recently spoke for the Council on Dental Practice for the 2016 American Dental Association Annual Meeting in Denver. He is also a past board member of the Organization of Asepsis & Prevention (OSAP) and is currently serving on OSAP’s Program Development Committee for its Annual Symposium.

Put Your Membership on Cruise Control ENROLL IN MEMBERSHIP AUTO-RENEWAL Members have a new way to pay dues. Starting with 2019 dues, the CDA will offer an auto-renewal service that provides a safe and convenient way to maintain your membership. Sign-up for auto-renewal and pay one lump sum or in 10-month installments. When you enroll in this program, your membership will always be current, so your benefits are uninterrupted. Enrolling is simple â&#x20AC;&#x201C; and after all, who doesnâ&#x20AC;&#x2122;t want to simplify their life? Questions? Contact CDA Director of Membership Erica Carvin at erica@cdaonline.org or 303-996-2842.

4th Quarter 2018 mddsdentist.com

RMDC SPEAKER

SOCIAL MEDIA CHALLENGES and How to Overcome Them By Rita Zamora

he social media marketing landscape continues to evolve and shift. Some practices are incredibly active

2) Why doesn’t anyone see or pay attention to our posts?

on Facebook, Instagram and even Snapchat—they

There could be a number of reasons for this. One reason is that not

enjoy being social and are rewarded with visibility,

many people even see your posts. Social@Ogilvy has reported that

likes, follows, reviews and word of mouth. On the other

organic Facebook reach may have declined to reach as few as 1-2% of

hand, there are those not familiar with or disinterested in social media

your followers. One solution to this reduction in visibility is to boost

who are just now realizing it’s important to get started or up-level their

your posts. Using the paid “Boost” option for your posts will significantly

social media efforts.

expand the number of people who see your content on both Facebook and Instagram.

Whether you are well-established on social media or just getting started, there are a number of challenges I continue to hear practices voice. Here

A second possible reason no one is paying attention to your posts, is

are the most common issues and tips to help overcome them.

your content may be generic, filler content—or maybe it’s just not that

1) How can we get people to like our Facebook page or follow us on Instagram?

interesting. If this is a problem, you can easily correct it by posting some creative, personalized, or engaging photos or videos. Fun giveaways, contests and patient appreciation campaigns are also popular.

A few years ago, it was easy to grow your page likes. You could put a sign up in your office, or simply ask people to like you, and they were happy to oblige. Today, the marketplace is crowded and people are more protective of their newsfeed real estate. The good news is, there are still several

3) Where can we find good images to use for our content?

techniques to grow quality likes and followers for your pages. Here are

If there is one pet peeve I have in social media marketing, it’s poor-quality

a few options:

images and graphics. We are in an Instagram economy. Images represent your brand and people are drawn to personalized, attractive or unique

- Install Facebook WiFi. It’s free and works automatically, inviting

visuals. What do you think blurry or sloppy images say to patients about

patients to check-in on their Facebook app while in your office:

your practice?

www.facebook.com/business/facebook-wifi You have a powerful tool in your purse or pocket: your smartphone - Invite Facebook post likes to like your page. If you aren’t inviting your

camera. Snap some photos of your team and practice. You can use a

post likers to like your page, you are missing out on valuable likes. For

variety of apps and filters or stickers to add some pizzaz to your photos or

example, we recently helped a client launch a Facebook giveaway for two

videos. The most popular posts I continue to see, are those with photos of

people to win a $25 gift card to a local ice cream shop. Out of 209 post

the doctor and team. Smart practices may snap a variety of pics in one day

likes, we were able to invite people to like the page and gained 40 new

and then spread out posting them in the future.

quality page likes! Simply click to see who the likers of your Facebook posts are and you’ll find the option to “Invite” them to like your page.

If you need images to supplement your personalized team photos, check out resources like these:

- Offer patients a special goodie, like an organic personalized lip balm or on-the-go teeth whitening pen, when they check-in, tag or follow

Free stock photo resources per HubSpot:

your practice on Instagram. Posts tagged with a location get 79% more

marketing/free-stock-photos

https://blog.hubspot.com/

engagement on Instagram (SproutSocial 2018) so you get the added benefit of visibility as well.

There are many paid stock photo options, this is just one: http://www. istockphoto.com/ Just be careful not to over use stock photos, remember it’s you and your team your patients want to see.

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There are also many dental cartoons and fun images you may find online. However, be very careful about copyrights for any images you decide to

5) We've run out of ideas on what to post!

use. Cite sources as image owners request. A graphics fee is a small price

Another benefit of using an editorial calendar (as mentioned above)

to pay to sleep well knowing you are using graphics with the proper

is you can plan your content strategy. A social media strategy isn’t

permission.

something you execute for one month and then it’s done—it’s an ongoing

4) We have trouble posting consistently - what can we do?

strategy for long-term benefit. What are the themes you are posting about on a consistent basis? Perhaps it’s a philanthropic effort your practice is involved with. Or you may have set a goal to increase the amount of

Understand that it’s more important to be communicative on social

dental implant treatment or sleep dentistry you perform and that will

media, rather than consistent. Yes, it may look like you’ve fallen off the

require that you promote those procedures every month.

face of the earth if you don’t post anything for two years. However, people understand you have a business to run and they don’t expect you to be

In some cases, you may just need some outside energy, ideas or creativity.

on social media constantly. Patients will understand if you post that

There are a multitude of online courses, webinars, and coaching available.

you will be out of the office for the holiday season or vacation—just say

Another option is to take a coffee break and peruse other practices’ social

something about it rather than disappearing.

media to gain some motivation and inspiration.

One of the most important tools you can use for social media is an

About the Author Ms. Rita Zamora is an international speaker and published author on social media marketing and online reputation management. Her advice on managing an online reputation was published in the ADA’s Practical Guide to Expert Business Strategies. She has over 20 years of experience working hands-on in

editorial calendar. The only way you can be strategic about what you are posting on social media is to plan for it. An editorial calendar is essentially a content plan for the month ahead, which helps with consistency as well. What types of treatments do you want to do more of or be known for? Include those topics in your plan. You can take your planning one step

dental practice marketing, as well as case presentation and consulting.

further by scheduling your content in advance, using Facebook’s free scheduling tool or by using a tool like Hootsuite to schedule content for multiple social media sites.

NEW NAME, NEW BRAND

SAME GREAT SERVICE, EXPERTISE AND PARTNER We are proud to share this exciting news with you! Dr. Aldo Leopardi’s Practice has always been at the forefront of Prosthodontics, leading the way with the most innovative and up-to-date practices and techniques. Now the time has come for our brand to evolve into a new entity. The all new DenteVita Prosthodontics will feature a new name, new logo and new company identity which will be unveiled throughout all future communication pieces. Dr. Leopardi states, “This rebrand is the next step in my ongoing goal of helping patients transform their lives with increased functionality as well as improved aesthetics. In the coming months you will see an evolution of my brand. Be assured my team and I will continue to provide the very best Prosthodontic services for you and your patients.”

Interested in how DenteVita can improve your patient care without adding overhead cost? Aldo Leopardi, B.D.S., D.D.S., M.S.

Prosthodontist

Let’s talk. Call us at (720) 488-7677.

About DenteVita

DenteVita specializes in aesthetic, implant, fixed and removable dentistry. We emphasize patient comfort, increased functionality as well as improved aesthetics in a confident atmosphere. DenteVita’s patients are immediately assured their image is in good hands right from the first impression.

7400 EAST CRESTLINE CIRCLE, SUITE 235 // GREENWOOD VILLAGE, COLORADO 80111 // DENTEVITA.COM

TRIPARTITE NEWS

CDA House to Review Longstanding Policies â&#x20AC;&#x201C; Dr. Kessler Elected 14th District Trustee Elect By Greg Hill, JD, CAE

s I am writing this article for Winter issue of the

will exhibit inside the hall to promote our line of endorsed products. We are

Articulator, I am fresh from the ADA meeting in

excited for this opportunity as CDA Enterprises seeks to grow its business and to

Honolulu. I am always excited to see what transpires

support RMDC in this new way. Be sure and drop by and see how CDAE and our

during the four days of the House of Delegates

endorsed programs can help you and your practice save money on products and

business and am always interested in how the Colorado Dental

programs that weâ&#x20AC;&#x2122;ve already negotiated lower prices for you.

Association (CDA) can build upon the resolutions passed by the ADA. This year is no different. In the next few months, we will be reviewing the policies of the American Dental Association and how the CDA can help advance those policies through its own governance. This policy review will be a major piece of our work this year. At the CDA House of Delegates this past June, the delegates approved Resolution 11-18-B, which calls for a review of all policies approved by the CDA House of Delegates that have been in existence for more than ten years (and less than twenty) to either amend, reapprove or delete. As part of this review, two taskforces have been created by the Board of Trustees, one to review

"In the next few months, we will be reviewing the policies of the American Dental Association and how the CDA can help advance those policies through its own governance."

About the Author

Greg Hill has served as the Executive Director of the Colorado Dental Association since June of 2014. Prior to joining the CDA, Greg was employed by the Kansas Dental Association for 15 years and served as the Assistant Executive Director of the CDA and Executive Director of its Foundation. Mr. Hill is a 1999 graduate of the Washburn University School of Law in Topeka, KS and a 1994 graduate of Kansas State University with a Bachelor of Science in Economics. He became a Certified Association Executive (CAE) in 2016. In addition, he serves as Co-Chair and Treasurer of Oral Health Colorado; on the Board of Directors for the Colorado Dental Lifeline Network and the Colorado Mission of Mercy; and is a member of the Denver Tech Center Rotary Club. He and his wife, Gwen, are the parents of daughter, Haven, and son, Camden.

access to care related polices, and the other to review policies related to dental practice. These policies, along with those approved in the last ten years, will be incorporated into an official policy manual. This manual, along with a Governance and Operations Manual which contains governance policies of the House of Delegates and the Board of Trustees, will be presented to the CDA House of Delegates this summer. Simultaneously, the Governance Taskforce, created by 16-18-B, is currently reviewing the governance structure of the organization of the House of Delegates, Board of Trustees and the Executive Committee and will bring a report to the House next year. These may include bylaw changes or policy recommendations designed to create an effective and efficient organization for the future as outlined in the 2016 CDA Strategic Plan.

January 17th - 19th, 2019 at the

I would also like to congratulate MDDS member and CDA past president, Dr. Brett Kessler, who has been elected by the ADA 14th District as Trustee and will begin serving as an ADA Trustee at the conclusion of the 2019 ADA House of Delegates. That ADA term is four years. I look forward to working with Dr. Kessler in this exciting new position. Finally, I look forward to seeing you at RMDC in Denver and wish MDDS a successful meeting. The CDA will have a booth outside the exhibit hall as we always do, but this year for the first time, its for-profit-subsidiary, CDA Enterprises,

28 4th Quarter 2018 mddsdentist.com

303.462.3744 www.peeblesdentallab.com

VISIT US AT BOOTH # 548

“Because of DLN dentists, veterans like me are getting the dental services we need.” Will you see ONE to CHANGE a life? WillYouSeeONE.org

You can change a life From clearing up painful dental infections and being able to eat again to rejoining

the workforce – volunteering with Dental Lifeline Network’s Donated Dental Services program will make a life-changing difference for the people we serve.

4th Quarter 2018 mddsdentist.com

Did You Know? The Mountain West Dental Institute (MWDI) has space for your next team meeting?

- Free AV - Free Parking - No Catering Restrictions Perfect for staff retreats, team-building or business meetings! Affordable rates starting at under $200 for MDDS members.

MOUNTAIN WEST DENTAL INSTITUTE 925 Lincoln Street, Unit B, Denver, CO 80203 | (303) 488-9700 | MWDI.ORG

EVENT CALENDAR JANUARY

MARCH

January 17-19 Rocky Mountal Dental Convention Colorado Convention Center 700 14th Street Denver, CO 80202 (303) 488-9700

March 8 Silver Diamine Fluoride: Application and Use in the Dental Practice -Dr. Jerod Leff Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 11:00am (303) 488-9700

FEBRUARY February 12 CPR & AED Training -Life Rescue CPR Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700 February 22-23 Moderate Oral Sedation for the Pediatric Dental Patient: Featuring Emergency Simulations -Drs. Nelle Barr, Stacy Jackson, Quen Ly, Jeffrey Young and Sean Whalen Children’s Hospital Colorado Anschutz Medical Campus 13123 E. 16th Avenue Aurora, CO 80045 8:30am – 3:00pm (303) 488-9700

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APRIL April 12 Botulinum Toxin (Xeomin, Dysport, Botox) and Dermal Fillers Training, Level I -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700 April 13 Botulinum Toxin (Xeomin, Dysport, Botox) and Dermal Fillers Training, Levels II & III -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

April 13 Frontline TMJ, Headaches and Orofacial Pain Level I -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700 April 17 CPR & AED Training -Life Rescue CPR Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700

MAY & JUNE May 31-June 1 Dental Sleep Principles: Where the Rubber Meets the Road -Drs. Terry Bennett and Chase Bennett Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700

CLASSIFIEDS

Jobs Endodontist - Peak Dental Services is looking for an Endodontist, part time or full time. This position will cover 5-7 locations in Colorado Springs. We offer internal and external referrals from our network of 25+ practices, all practices are fee for service and accepts PPO insurance (no HMO, no Medicaid). Fully equipped for Endodontists, including CBCT, Microscopes and your own dedicated Endo team. Earning potential upward of $400-600k annually. Please apply to https://peak-dental-services.workable. com/jobs/643925 General Dentist - Greeley Dental Health located in Greeley, Colorado is currently in search of a General Dentist. Greeley Dental Health has been in business for over 22 years and has over 500+ positive Google reviews. Receiving over 70+ new patients per month and a clear path for dentists to generate $+300K annual income. We offer 80 hours of CE courses annually. For more information please apply https://peak-dentalservices.workable.com/jobs/782920 General Dentist - Panorama Dental located in Aurora is looking for a General Dentist. Focused on delivering a positive customer experience, Panorama Dental has 4.9 out of 5.0 google ratings with over 350+ positive Google reviews. Receiving upwards of 100 new patients per month and a clear path for dentists to generate $+300K annual income. We offer 80+ hours of CE courses annually. For more information please apply at https://peak-dental-services.workable.com/jobs/856659 Hygienist - Small boutique office in Littleton looking for a Hygienist. Our long time lead hygienist is retiring to take care of her parents. Looking for someone Tuesday, Wednesday, Friday. We can split up the days to accommodate your needs. Please email your resume to Dentaloffice811@gmail.com. We truly look forward to meeting you. Dental Hygienist - One of our Hygienist of 14 years is retiring in late December. Looking for an RDH Mondays, Tuesdays and Thursdays 8-5 in Parker starting January 7, 2019. Please send your resume to office@rodneyallendds.com or fax to 720-8516790. General Dentist - The Cody Dental Group (www.codydental.com) located in Southeast Denver is seeking a general dentist associate. Four or more years of practice experience required. Willingness to accept insurance required. Your existing patients are welcome. An initial group of insured and private-pay patients will be provided by

Cody. Excellent opportunity to grow a practice in a collaborative environment of 12 highly experienced, general and specialty dentists. For more information contact Tom Oberle at 303-638-6491 or tomoberle@codydental.com. Periodontal Associate - Looking to add a Periodontal Associate position for a solo private practice in Centennial, Colorado, with the potential to "buy-in" to the practice. Current Owner/Periodontist, who has been in practice for +25 years, is looking to reduce his work schedule. Day and hours are flexible. State of the art office and the latest technology including lasers and 3 dimensional Green CBTC scanner. We are a fee for service office and accept PPO insurance (no HMO or Medicaid). If you are interested in applying for this position, please email your CV with a letter of introduction to jankowski6@hotmail.com, or, call Cheryl at (303) 762-0621.

Real Estate Dental office space available January 1 - 2450 SF office plumbed for 6 ops. Includes compressor and vacuum and a pano. Rent is about $4000/mo. Space is clean and ready for dental use as of January 1st, 2019. Good landlord. Iâ&#x20AC;&#x2122;m moving to an owner occupied location. 4380 S Syracuse St, #502. Denver, co 80237. Good location in DTC without tech center rental rate. Staff knows about the move so tours are fine. Contact drchris@macridental.com. GP in Aurora (CO 1816) $880K collections, $315K net income, practice must be relocated, dentist/owner desires to stay on email: frontdesk@adsprecise.com, 303-7598425. GP in Boulder (CO 1815) Dr. relocating out of state, Collections $600K, 5 OPS. email: frontdesk@adsprecise.com 303-759-8425 GP Practice: Pueblo (CO 1808). Doctor retiring. Annual revenue $300,000. 3 ops. Contact frontdesk@adsprecise.com or 303-759-8425 Associate to Buy-In 50% of Practice in Denver (CO 1806) 3 OPS, 900K in collections. For more information, please call 303.759.8425 or email frontdesk@adsprecise.com

MEMBER BENEFIT PATIENT HIGHLIGHT INFORMATION FLIERS MDDS is proud to release its newest member benefit. The Member Services Committee has worked diligently to create a library of free, printable patient education fliers. These fliers are a member only resource available by logging in to mddsdentist.com with your email address and ADA number. Provide your patients with information on pediatric dentistry, root canal therapy, restorative options and more!

3rd Quarter 2017 mddsdentist.com

Do you have an idea for a flier you would like to see us create? Contact Cara Stan, MDDS Director of Marketing & Communications at marcom@mddsdentist.com.

4th Quarter 2018 mddsdentist.com