AGD Impact
Navigating Implant Success with Photogrammetry
Navigating Implant Success with Photogrammetry
By Leila Zadeh, DMD, FAGD
Advances in digital technology and the relatively recent incorporation of photogrammetry — a method of approximating a 3D structure using 2D images — in dentistry not only improve the accuracy of capturing implant relationships in a 3D space but also help streamline the final impression process so that it is significantly faster and easier than traditional analog workflows.
What Makes a New Graduate Employable?
By Brooklyn Janes
As students approach the finish line of dental school, their minds are shifting into “work mode,” thinking about the realities of postgraduation life. This transition often causes them to reflect on what they want as they start their careers. But first — what are hiring managers even looking for in a new graduate?
Positivity and Perspective
Leaders must maintain positivity and perspective. This is true in all business relationships. Speaking positive words around team members and colleagues creates an ability to think big, heal and become successful in any endeavor. Happiness grows the mindset and creates positive energy. You are not prodigious because you haven’t failed at something; you become celebrated because failures haven’t stopped you from accomplishing your goals. Failure is simply the opportunity to rise again, but this time with more forethought and acumen.
In addition to running a full-time dental practice, I travel around the country dozens of times a year to provide continuing education lectures and hands-on courses. I am often asked how I do all the things I do and keep a positive attitude. I attribute much of my success to the people around me, both those on my team and those who served as educators and mentors. They have helped me stay positive, and they give me perspective.
I have been educated by so many colleagues. Getting the right people around you can make the difference between a content existence and an exceptional quality of life. The best educators and leaders share good and bad results and attempt to eliminate the stresses associated with negativity. A beautiful end result is nice and may be motivational, but so too is seeing the steps that lead to excellence. This perspective is invaluable. You can appreciate the view from the mountaintop so much more if you remember the journey that got you there.
The best educators also find a way to give even the harshest criticisms a positive spin. Dentistry is hard and sometimes extremely frustrating. Taking criticism from others, whether it be patients or colleagues, may appear counterproductive, but, when done properly, can be addressed as advice to just
become better. If we become fixated on the negatives, we can create an anxious state and stagnate. Being able to take action to better ourselves based on criticism creates positive feelings, and it elevates our careers. Embrace life, and don’t just accept the negatives — act on them to become a better practitioner.
Positivity also translates to the patient experience. Having a constant positive attitude when treating patients is the foundation for ethical, practical and compassionate therapy. The public trusts that we are providing the best innovative service using modern techniques and technology. Overtreatment for financial gains is against the oath we take as health professionals. Our oath is a promise to do no intentional harm to our patients. Prevention is always preferable to eliminating or minimizing the disease process. Reminding ourselves of our promises when we graduate from dental school makes us more empathetic to needs and compassionate in therapy while creating respect in our community. With all the financial strains put on recent graduates, and even established providers, it may be easier to float into a mindset of financial gain over what is best for the person in our dental chair, but we must remain positive and remember that improving the oral health of each patient improves the overall health of the entire community. A rising tide lifts all boats. Success is not automatic. It takes hard work and physical and mental effort to meet the specific goals you have, but the rewards are what make us smile each day. Stay positive.
Timothy F. Kosinski, DDS, MAGD Editor
DISCLAIMER: The Academy of General Dentistry does not necessarily endorse opinions or statements contained in essays or editorials published in AGD Impact. The publication of advertisements in AGD Impact does not indicate endorsement for products and services. AGD approval for continuing education courses or course sponsors will be clearly stated. AGD Impact (ISSN 0194-729X) is published monthly by the Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600. Canadian Mailing Information: IPM Agreement number 40047941. Change of address or undeliverable copies should be sent to: Station A, P.O. Box 54, Windsor, Ontario, N9A 6J5, Canada. Email: impact@agd.org. Periodical postage paid at Chicago, IL and additional mailing office.
AGD members receive AGD Impact as part of membership; annual subscription rates for nonmembers are $80 for individuals and $120 for institutions. Online-only subscriptions are $85 for individuals and $110 for institutions. All orders must be prepaid in U.S. dollars. Single copies are available upon request. Please contact our Membership Services Center at 888.243.3368 for more information.
POSTMASTER: Send address changes to AGD Impact 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600. No portion of AGD Impact may be reproduced in any form without prior written permission from the AGD. Photocopying Information: The Item-Fee Code for this publication indicates that authorization to photocopy items for internal or personal use is granted by the copyright holder for libraries and other users registered with the Copyright Clearance Center (CCC). The appropriate remittance of $3 per article/10¢ per page is paid directly to the CCC, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. The copyright owner’s consent does not extend to copying for general distribution, for promotion, for creating new works, or for re-sale. Specific written permission must be obtained from the publisher for such copying. The Item-Fee Code for this publication is 0194-729X. Printed in U.S.A. © Copyright 2025, Academy of General Dentistry, Chicago, IL.
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Dental Practice Advocacy
2026 CDT
Code to Include Three New Codes Suggested by AGD
By Cindy Kluck-Nygren, AGD manager, Dental Practice
AGD’s Dental Practice Council (DPC) regularly reviews the Code on Dental Procedures and Nomenclature (CDT Code), managed by the American Dental Association (ADA) Code Maintenance Committee (CMC). During the 2024 review cycle, AGD identified the need for several new codes that, if adopted, would enable dentists to detail certain patient treatments more accurately. After identifying gaps in the CDT Code, the members of the DPC’s Subcommittee on the Comprehensive Review of the CDT Code prepared the documents needed in order to have the new submissions considered by the CMC. Those recommendations were submitted in July 2024.
At its March 7, 2025, meeting, the CMC voted on more than 90 recommended changes to the CDT Code. All of AGD’s CDT Code submissions were approved. See below for the new codes, which go into effect Jan. 1, 2026.
During the CMC meeting, Ralph A. Cooley, DDS, FAGD, and Arlene O’Brien, DMD, FAGD, AGD’s delegate and alternate delegate to the CMC, advocated for general dentists while championing AGD’s three requests for new listings.
“Although dentists use these codes every day in the practice, they may not realize how they are defined or how they come about,” said
Category of Service
Prosthodontics, Removable
Prosthodontics, Removable
Nomenclature
Cooley. “The CMC is the organization that makes that happen, and AGD has a seat at the table. This is just one way that the DPC and AGD advocate for the general dentist on matters that affect how they practice every day.”
“AGD members can look forward to some new codes about duplication of complete dentures — including one for maxillary and one for mandibular — and another code for cleaning and inspection of an occlusal guard,” said O’Brien. “These new codes matter since general dentists do these procedures on a daily basis.”
Voting members of the CMC include: the ADA; each of the 12 recognized dental specialties; AGD; the American Dental Education Association; the Centers for Medicare and Medicaid Services; and four third-party payer and dental benefits organizations.
AGD members who identify what they believe are gaps in the CDT Code and who would like AGD to consider sponsoring a request to add or modify the CDT Code on their behalf are encouraged to share that information with the DPC via email to practice.management@agd.org. Members are encouraged to review the ADA website for information about the “CMC Process Document” and the “CDT Code Maintenance Timeline” to ensure they’re providing the necessary information in their initial request to the DPC.
Descriptor
Duplication of complete denture – maxillary Does not involve all steps used in initial fabrication.
Duplication of complete denture – mandibular Does not involve all steps used in initial fabrication.
Miscellaneous Cleaning and inspection of occlusal guard –per appliance This procedure does not include any adjustments.
Leadership
Upcoming Executive Committee
Elections
Federal law requires most nonprofit professional societies, such as AGD, to have a democratic form of governance whereby association members elect their volunteer leadership in one form or another.
AGD’s Bylaws specify that the seven members of the Executive Committee (EC) be elected by the House of Delegates (HOD). Each year, the delegates, who are themselves elected or appointed from each constituentcy, meet in Chicago to, among
other tasks, determine the composition of AGD’s leadership group. With the exception of the office of vice president, the terms for the elected offices are staggered so that there will not be an election each year for each position.
A new vice president is elected every year, and that person automatically advances to the offices of president-elect and president in the subsequent years. The secretary is elected each odd year for a two-year term, with a maximum of two terms. The treasurer is elected each even year for a two-year term, also with a maximum of two terms.
For 2025, the HOD will meet Nov. 16 to elect the offices of vice president, secretary and speaker of the House of Delegates. Incumbent EC officers have a narrow window between June 1 and June 30 to declare for a different EC office. All other AGD members who are qualified to run must declare between July 1 and Sept. 23.
For more information about AGD’s elections, elections processes and job descriptions, please contact AGD Executive Director Daniel Buksa, JD, CAE, at 888.243.3368, x.4328.
Recognition
AGD Member Receives Distinguished Eagle Scout Award
John E. Regan, DDS, MAGD, LLSR, FACD, was recently included among the recipients of the National Eagle Scout Association’s 2024 Distinguished Eagle Scout Award (DESA). Established in 1969, DESA recognizes Eagle Scouts who achieve extraordinary national-level recognition, fame or eminence within their profession and/or service to the nation and have a strong record of voluntary service to their community. Each year, councils can nominate candidates who have been Eagle Scouts for at least 25 years to be reviewed by a committee of Distinguished Eagle Scouts. The 2024 class of recipients included 18 individuals total. Regan, who maintains a private practice in Huntington, Indiana, is a distinguished dentist and community leader whose career spans decades of groundbreaking contributions to his profession and community. He made history as the youngest appointee to the Indiana State Board of Dental Examiners. He later founded the Indiana AGD, serving as its president before
becoming president of AGD in 1980. Renowned for his expertise, Regan has published influential research in leading dental journals, helped establish national standards for dental products, and earned prestigious honors such as AGD Mastership and Lifelong Learning and Service Recognition. Beyond his professional achievements, he co-founded Pathfinder Services Inc., an organization supporting individuals with disabilities that now operates with a $22 million annual budget. Regan exemplifies leadership and service, indelibly impacting his field and community.
AGD PODCAST
Stay sharp between patients.
Tune into the AGD Podcast Series for fresh interviews with industry leaders, practice experts and changemakers in the profession who are shaping the future of dentistry. Quick, insightful, and always relevant — it’s the easiest way to stay informed on what’s happening in the profession.
Take a listen today!
The AGD Podcast Series is hosted by George Schmidt, DMD, FAGD, vice president of AGD. He welcomes guests to discuss the latest news and emerging trends in dentistry.
Dr. John Regan and his wife Delene
AI’s Place in the Future of Dentistry
By Amrita Feiock, DDS, FPFA, FICD, FACD
The future of dentistry is poised for an exciting transformation, driven by advancements in technology and artificial intelligence (AI). Over the past few decades, dentistry has undergone significant changes, from digital radiographs to the development of 3D printing for prosthetics. Now, as AI makes its way into dental practices, the field is expected to experience even more revolutionary progress, improving patient care, enhancing efficiency and altering the way dental offices operate, especially those in small business settings. AI has the potential to redefine the landscape of healthcare, and dentistry is no exception. AI can process vast amounts of data, recognize patterns, and perform tasks more accurately and efficiently than humans in certain areas. One of the key applications of AI in dentistry is in diagnostics. Machine-learning algorithms can analyze images such as radiographs, CT scans and 3D scans to identify issues such as carious lesions, gum disease and even oral cancer at early stages, often before they are visible to the human eye. This early detection can significantly improve patient outcomes, as it allows for more timely interventions.
Additionally, AI-powered software can assist in treatmentplanning. With the help of AI, dental professionals can receive data-driven recommendations on the most effective treatment options for individual patients, reducing human error and optimizing clinical decision-making. For instance, AI systems can be trained to assess a patient’s specific dental needs based on their medical history, genetics and lifestyle, thereby providing personalized care.
Making Care Faster and More Affordable
AI can also enhance the overall patient experience by streamlining office operations. Dental practices are often burdened with administrative tasks, such as appointment scheduling, insurance verification and patient communication. AI tools can automate many of these processes, freeing up dental staff to focus on more critical patient care tasks. AI chatbots, for example, can manage appointment scheduling and answer patient inquiries, ensuring efficient communication and reducing waiting times.
One of the most exciting prospects of AI in dentistry is its potential to make quality care more accessible. Dental services can be costly, especially for underserved populations, but AI has the ability to help bridge gaps in care. AI-driven diagnostic tools can be used in community health centers or remote areas where access to specialized care may be limited. For example, AI-powered mobile dental apps can help people identify dental problems and even offer basic treatment recommendations without requiring immediate access to a dentist. By streamlining diagnostic procedures, treatment-planning and administrative tasks, AI can help reduce overhead costs. Smaller practices and solo practitioners
may benefit from these cost savings, as they will be able to provide high-quality care without incurring the expenses of large administrative teams or costly diagnostic equipment.
AI and Small Practices
Small dental practices are an integral part of the healthcare ecosystem. They provide personalized, patient-centered care and are often more agile and flexible than large corporate dental chains. However, small businesses face unique challenges, particularly in terms of competition with larger chains, overhead costs and the pressure to stay up to date with rapidly advancing technology.
One of the most significant advantages of AI for small dental practices is the ability to level the playing field. AI tools, which were once prohibitively expensive or only accessible to larger organizations, are becoming more affordable and user-friendly. Small dental offices can integrate AI-powered diagnostic tools, automated scheduling software and even virtual assistants without breaking the bank. These technologies can help reduce costs and improve efficiency, making it easier for small practices to compete with larger dental chains that have more resources.
Moreover, AI allows small practices to enhance the patient experience in ways that were previously only possible in high-end or corporate settings. With AI-powered diagnostic software, small dental offices can offer cutting-edge care that rivals the largest practices in the industry. Patients are more likely to be satisfied when they receive fast, accurate diagnoses and personalized treatment plans, which, in turn, lead to higher retention rates and increased word-of-mouth referrals.
AI can also help small practices reduce overhead by automating administrative tasks, allowing dental teams to focus more on patient care and less on paperwork. Automated scheduling, billing and insurance verification reduce the likelihood of human error
and streamline office management. With AI’s ability to handle many of these tasks, small dental practices can operate more efficiently and keep costs lower, helping them remain competitive in a marketplace that is becoming increasingly driven by technology.
Challenges and Concerns
While the integration of AI in dental practices is undoubtedly promising, there are also ethical and practical considerations to keep in mind. One concern is data security. Dental practices handle sensitive patient information, and, as AI tools rely on large datasets to function, ensuring that patient data remains private and secure is paramount. The adoption of AI technologies will require dental professionals to implement robust cybersecurity measures and adhere to strict privacy regulations.
Another challenge is the potential for technology to replace human expertise. While AI can assist with diagnosis and treatment-planning, it is not a substitute for the human touch that patients value in healthcare. Dental professionals must continue to exercise their clinical judgment and communicate effectively with patients, even as AI aids them in providing care.
The future of dentistry is undoubtedly intertwined with the rise of AI. The technology holds the promise of improving diagnostics, enhancing patient care and streamlining operations in dental practices. However, as with any technological advancement, the integration of AI must be approached thoughtfully and responsibly, with careful attention paid to ethical considerations, data security and the preservation of the personal touch that defines quality healthcare. As we move forward, AI has the potential to revolutionize dentistry while keeping it grounded in patient-centered care. ♦
Amrita
DDS, PC, in Westchester County, New York. To comment on this article, email impact@agd.org
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Now is the time to take advantage of AGD’s SelfInstruction program that includes exercises based on AGD Impact articles. These exercises contain 10 questions and are worth 1 CE credit. It’s the perfect complement to General Dentistry.
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Feiock, DDS, FPFA, FICD, FACD, is in private practice with her father, endodontist Rohit Z. Patel,
Three Ways to Increase Production Right Now
By Roger P. Levin, DDS
The key to success in dental practice is production. This will never change. Regardless of how much clinical continuing education dentists take, where they locate or even how strong a team they put together, ultimately, all this needs to translate into increased practice production. Unfortunately, there are many dentists who have dedicated incredible time and effort to their practice and patients, but, in the end, do not have enough to show for it due to production decline. This is why the business side of dentistry is just as important as the clinical side.
The Best Time to Increase Production
In an ideal world, every dentist would have a production model before starting practice. Whether opening a practice or joining one, it is always best to know exactly how you are going to make the business successful before you start. However, in the real world, this rarely happens. In the past, dentists were able to simply open practices anywhere and be successful due to patient demand. While this is still true in some areas, the reality is that competition has increased, and success is no longer guaranteed. Some dentists will have outstanding careers, and others who are just as dedicated will struggle. The difference will be the level of practice production they are able to achieve.
The best time to focus on increasing practice production is if your growth goes flat or starts to decline. Either of these key performance indicators means that something needs to be addressed before it worsens. When things are declining in a business, it will get worse if nothing is done. Today, dentistry has more competition, staff shortages and challenges than ever before. This does not mean that practices cannot have amazing success, but it does mean that you must be intentional about making it happen.
Start by looking at these key numbers for your practice:
• Production.
• Production per day.
• Production per hour.
• Production per patient.
• Number of new patients.
• Production per new patient.
• Production as a ratio of overhead.
These numbers alone will tell a detailed story that will help you determine whether you are improving, flat or declining. If production is not growing by at least 5% per year, then you should address it immediately. If you are flat or declining, you should address production with a crisis approach.
Three Ways to Increase Production
If you need to increase production quickly, there are many strategies and models to implement. The following three will immediately increase your overall production and start your practice on the road back to growth.
1. Increase fees. This may seem obvious; however, many practices do not raise fees annually or by enough. They are afraid to raise fees because they believe that patients won’t accept them. In my experience as the CEO of a leading practice management consulting firm, I have found that patients really don’t focus on fee increases. They may decline a treatment because of the total price, but not because the fee is slightly higher. Remember, the increases need to occur annually. In American economics, we look at annual rates like the consumer price index, interest rates, etc.
Practices need to act responsibly regarding covering overhead, increases in team compensation and other factors. One of the most effective means to address this is to increase fees accordingly. Then you must concentrate on excellent case presentation, building value and providing great customer service.
2. Identify all possible treatment. I am frequently surprised at how many practices have patients who need extensive treatment that has not been recommended (or performed). This is evidenced by many practices that are sold to new dentists who immediately identify necessary or desirable treatment and are able to increase
practice production in a very short time. In fact, we recently worked with a practice that was producing $490,000 per year and was sold to a young dentist. Three years later, the practice produced $1.2 million per year, and all the trends indicate that this will continue.
Practices simply fall into the habit of recommending what is obvious and needed now, rather than regularly performing comprehensive exams (on all patients) and making associated treatment diagnoses. The good news is that practices should view this as a great opportunity to increase production and move to the next level.
3. Decrease no-shows. This one is a little harder to understand because it is often invisible. Most practices do not know their no-show rate or how many hours per year of open appointments exist for patients who either don’t show or cancel at the last minute (which is the same as a no-show). A Levin Group study showed that over a 36-year career, most practices will lose over $3 million of revenue strictly from no-shows. This is a significant revenue loss and can be amortized year by year. If the no-show scenario is reversed, then practice production will increase immediately.
To reduce no-shows, the practice needs to build significant value in each appointment (including hygiene), and that can start with the front desk staff reminding patients why the appointment
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is so important. Dentists and assistants need to do this as well. Another technique is to confirm appointments properly at two weeks, two days and two hours. Furthermore, practices should reach out to patients immediately if they are no-shows and let them know that there is a charge for missed appointments that will be waived this time but billed in the future. Patients who continue to be no-shows regardless of how they are handled should be relegated to a short list of patients that should only be called when there are last-minute open appointments. By cleaning up the no-show situation, you will again increase production — and by far more than you might think.
Summary
Production is the single most important factor in determining the success of practices and financial independence for dentists. Dentists invest heavily in their careers by going to dental school, taking on student loan debt and buying practices. Therefore, dentists deserve a return on investment, and the only way to guarantee that return is to have excellent production that increases every year. ♦
Roger P. Levin, DDS, is the founder and CEO of Levin Group, a dental management consulting firm. To receive his Practice Production Tip of the Day, visit levingroup.com. To comment on this article, email impact@agd.org
Navigating Implant Success with Photogrammetry
The How, When and Why
By Leila Zadeh, DMD, FAGD
In the United States, more than 36 million people are completely edentulous, and approximately 120 million people are missing at least one tooth.1 Solutions in the form of fixed-implant prostheses, such as all-on-X hybrids or implant bridges, are invaluable treatment options because they more closely approximate both the function and esthetics of healthy, natural dentition than their removable counterparts. Advances in digital technology and the relatively recent incorporation of photogrammetry — a method of approximating the 3D orientation of objects using 2D images — in dentistry not only improve the accuracy of capturing implant relationships, but they also help streamline the final impression process so that it is significantly faster and easier than traditional analog workflows. This article will explore the how, when and why behind this cutting-edge technology that is revolutionizing implant dentistry and discuss the clinical implications for you and your practice.
A Glance at the Past: The Traditional Analog Approach to Full-Arch Impressions
It was during my advanced education in general dentistry residency when I first realized how time-consuming and technique-sensitive the fabrication of passively-fitting implant prostheses could be. This became evident when I performed my first all-on-X surgery. The implants had great primary stability, so I was comfortable immediately loading the milled acrylic surgical interim. However, the analog interim denture conversion with temporary cylinders and salt and peppering powder acrylic was much more difficult than I had anticipated. I ended up working all through lunch until just after the clinic closed by the time the interim was finally inserted, occlusion double-checked, and the patient’s transformation completed.
Flash forward a few months later, and it was time for the final impression for her zirconia-fixed hybrid denture. Unsurprisingly, the traditional analog workflow we used took an entire morning block and most of lunch, with the not-so-patient patient waiting in the dental chair while I
“Before PG, we took 2–3 hours to combine the final impression steps and all the records, all of which was pure ‘doctor-time.’ After PG, this same appointment is now down to 1–1.5 hours and is almost completely delegated to our staff, with the total ‘doctor-time’ being only a 15–20-minute sliver of the total appointment.”
— Nate Farley, DDS, MS, FACP
spent the majority of my time doing lab work and running back and forth from the operatory to the lab, pouring up alginate impressions, making and luting together an implant verification jig, making several chairside polyvinyl siloxane impressions, and cross-mounting casts. Adding to the pressure to be both speedy and accurate was the knowledge that the more steps that were needed, the higher the potential for cumulative error.2
Although I was a new dentist who had never done this procedure before, I knew from having spoken to my prosthodontist mentors that conventional denture conversions and final impressions for fixed detachable hybrid dentures — even when done in this exact way in their experienced hands — can frequently take up most of a morning or afternoon block. That was, until the incorporation of photogrammetry technology.
Making New Waves in Implant Dentistry: What Is Photogrammetry, and Who Is Using it?
Broadly defined, photogrammetry (PG) is a “method of making precise measurements by using reference points in photographs.”3 More specifically, it is a “technique for determining the geometrical characteristics of objects and their 3D spatial orientation by recording digital images following a specific protocol,” and it is used in dentistry as a means to digitally transfer intraoral implant locations to computer-aided design (CAD) software.4 First used in implant dentistry as early as the mid-1990s, PG was proposed as an alternative to conventional
full-arch implant-supported impressions by Torsten Jemt et al. in 1999.3,5-7 Some of the different PG systems currently available on the market include iCam4D (iMetric), MicronMapper (S.I.N. 360), PIC System (PIC Dental), and Blue Sky Bio Grammee (powered by Tupel 3D), and, while each system has its differences, they all aim to better capture the spatial positioning of implants relative to each other by bringing the accuracy of a desktop scanner to the mouth. This is incredibly useful because intraoral scanning alone is currently not accurate enough for the final impressions of edentulous arches for full-arch implantsupported prostheses.4,5,8,9 Compared with intraoral scanners, PG scanners also do not have the same stitching errors because all of the scan body data is captured at once with each picture; their accuracy is not as influenced by patient movement or by blood, saliva and other residue; and their multiple cameras have a larger scanning range and faster scanning speed.3,10
Having only restored all-on-X prostheses the conventional, analog way during residency, I was fortunate to work and train with new digital workflows in private practice, where I experienced firsthand how PG can streamline and simplify the full-arch final impression process chairside to a mere 30 minutes, saving the operator time, money and tremendous headaches. I quickly found that many others felt the same way.
“PG has been a complete gamechanger for my practice,” explained Nate Farley, DDS, MS, FACP, a board-certified prosthodontist, founder of digitalDDS, a continuing education company that
Fig. 1: In this case example for a final maxillary all-on-X restoration, after multiunit abutments were torqued down, iMetric domino scan bodies were placed and scanned with the iCam 4D unit.
positions in space.
3: iMetric soft tissue cylinders (iCam Refs) were then placed, and a new Trios scan was used to capture the teeth, palate and soft tissue cylinders.
teaches dentists digital dentistry and simplifies CAD/CAM (computer-aided design/computer-aided manufacturing) workflows, and co-creator of whatimplantisthat.com. “Before PG, we took 2–3 hours to combine the final impression steps and all the records (e.g., bite, mounting, scanning interims, etc.), all of which was pure ‘doctor-time,’ with technique-sensitive steps that could not be outsourced to anyone else on
Fig. 4: In Exocad, the new scan taken in Fig. 3 was aligned to the scan of the approved surgical interim prosthesis via common keratinized tissue points on the palate (blue arrow). The implant position information was exported out of the iMetric software in the shape of iMetric soft tissue cylinders, which were then aligned with the soft tissue cylinders scanned intraorally in Fig. 3 (yellow arrow). Now that all these scans are aligned to each other, a prototype can be fabricated for the patient to test-drive prior to designing the final restoration.
the team. However, after PG, this same appointment is now down to 1–1.5 hours and is almost completely delegated to our staff, with the total ‘doctor-time’ being only a 15–20-minute sliver of the total appointment. This has greatly improved our chair time, and we — as well as our patients — have really enjoyed how our schedules have opened up as a result.”
Because of its efficiency, this technology is increasingly being used not just
by prosthodontists, but also by general dentists who restore a lot of implant prostheses. I’ve noticed an interesting trend in an increased demand for oral surgeons to create and deliver full-arch surgical interims themselves for the general dentists with whom they work.
However, due to the relatively high cost of a PG unit (as of fall 2024, the iCam4D is about $40,000; the Grammee by Blue Sky Bio is about $18,000; the MicronMapper is
Fig. 2: (Left) The iCam 4D scanner. (Right) The scanner in action capturing the implant
Fig.
Fig. 5: (Before and after views.) The final delivered prosthesis was a zirconia sleeve on a titanium bar (Renew Full Arch Lab).
Note: Figs. 1–5 are courtesy of Revive Dental Implant Center.
about $27,000; and PIC ranges from about $33,000 to $40,000), investing in this technology is not practical or cost-effective for practices that do not work frequently with implants. As a result, many dental labs are investing in PG systems and sending technicians chairside to assist dentists with these workflows so that clinicians can get the benefit of this technology without committing to buying a unit. However, according to prosthodontist Kimberly Schlam, DMD, MS, owner of Bend Prosthodontics and a Spear Education faculty member, if utilizing an external lab for its photogrammetry services, it is important to remember that the responsibility ultimately lies with the clinician for the implant position. “This is why I prefer taking my own PG scans,” Schlam said. “As the provider responsible for the prosthesis that will be delivered, I will be the person helping the patient manage the prosthesis into the future, so I do not let any technicians make final impressions of my implants either digitally or conventionally, and I also double-check the passivity of my implant prostheses clinically and radiographically.”
Photogrammetry Unveiled: How to Use This Technology
The basic idea behind any PG unit is that it uses an external camera to scan intraoral markers and record the spatial position of implants relative to each other in a 3D space, and this information is stored as an STL (standard tessellation
language) file, which is a file format for 3D objects (Figs. 1 and 2). Because the PG unit itself does not capture any information about the soft tissue and/or any possible teeth remaining in the arch, a second scan by an intraoral scanner or a digitized conventional analog impression is needed to capture this additional data, which is also stored in STL file format (Fig. 3). These STL files can then not only be aligned to each other, but they can also be aligned to the preoperative scan of the original teeth when making a surgical interim or aligned to the approved surgical interim when designing your final prosthesis (Fig. 4). CAD software such as Exocad can be used to fabricate a prototype or the final implant-supported prosthesis, which can then be printed or milled (Fig. 5). The beauty of this workflow is its flexibility — any portion of the CAD/CAM process can be outsourced to a dental lab or handled in-house.
When Is Photogrammetry Indicated, and How Accurate Is It?
In addition to full-arch cases, PG can also be used to quickly and accurately capture the implant relationships for an implant bridge instead of spending the time to make an implant verification jig and/or luting the implants together chairside. PG can be used to eliminate the need for messy and timeconsuming denture conversions on the day of implant placement if the surgical interim prosthesis is designed in advance. PG scans recording the implant positions can be quickly incorporated into this predesign so that the resulting surgical interim can be printed or milled for same-day delivery. This can be coordinated with your local dental lab, or you can incorporate either part or all of this workflow in-house to save on costs. Although two recent systematic reviews published in the Journal of Prosthodontics10 and the Journal of Prosthetic Dentistry11 concluded that PG is a reliable tool for recording implant positions, and many studies support
“I prefer taking my own PG scans. As the provider responsible for the prosthesis that will be delivered, I will be the person helping the patient manage the prosthesis into the future, so I do not let any technicians make final impressions of my implants either digitally or conventionally.”
— Kimberly Schlam, DMD, MS
“Dentists should be careful not to treatment-plan fullarch implant-supported prostheses based solely off clinician preference but instead decide to do these cases according to what is best for the patient. It is our duty to educate
patients
about the pros and cons of all treatment options because implants are not without complications.”
— Kimberly Schlam, DMD, MS
implant arena, and digital workflows have simplified this procedure significantly,” Crockett said. “The Optisplint is similar to a conventional verification jig, but it uses scan bodies instead of impression copings. They are linked together in the mouth with resin, and an intraoral scanner is then used to capture all necessary scans, such as tissue, interocclusal record and biocopy.”
the accuracy and/or long-term survivability of prostheses made utilizing PG as being either superior or comparable to analog conventional full-arch implant impressions,2,3,7,12-16 there are a few studies that have reported the latter to be more accurate.4,17 Thus, the general consensus is that PG is increasingly showing promise, and more dental research is indicated to establish its reliability in different clinical situations more consistently, as the current scope of research on the subject is relatively limited.2
Some important factors to consider when assessing the validity and applicability of these existing studies are:
• The influence of study limitations on the conclusions drawn (i.e., small sample size, whether the study was done in vivo, etc.).
We must also recognize that when we practice evidence-based dentistry, systematic reviews and meta-analyses should be given more weight than other study types.
• How the results might have been influenced by implant factors, such as whether the impression is implant or abutment level, implant angulation, apico-coronal depth, type of connection, inter-implant distances, intraoral factors (saliva and mucosa movement), the operator’s experience, and different environments (i.e., maxilla or mandible, room temperature or humidity, etc.).2,12 Additionally, the “design, wear, or torque displacement of the PG markers” could also affect the accuracy.10
• The fact that these findings are specific to the particular workflow employed in the study in question (i.e., the specific PG system, intraoral scanner and scan path, scan bodies, and/or implant configurations used).4
• Which methods were used to assess accuracy in these studies, as these can influence the accuracy of different impression techniques.2
Therefore, future research is indicated to rule out the influence of these variables, and we should always be careful when assessing studies as to whether the conclusions drawn can be generalized to all of PG as a whole. This is important so that we are comparing “apples to apples” when making our own clinical decisions based on the body of dental literature available.
Other Tools in our Toolkit: Photogrammetry Alternatives
As useful as PG can be, it also has some downsides besides high cost. It is a modelless workflow, which makes cementing titanium bases either impossible or a challenge and prevents checking the accuracy and passivity of the implant-supported prosthesis on a verified master cast prior to delivery. Additionally, you still need to use an intraoral scanner to capture the shape of the soft tissue and/or any existing teeth against which the prosthesis will be built.
Trying to find a more cost-effective alternative to PG to get the best of the analog and digital worlds, Russell J. Crockett, DMD, prosthodontist and founder of the company Digital Arches, spent the early COVID-19 pandemic quarantine days developing the Optisplint® (by Digital Arches), which is the first and only scannable full-arch analog and digital verification jig.
“Complexity and cost can be huge barriers for dentists entering the full-arch
“The benefit of Optisplint is that it gives clinicians the benefits and advantages of digital scanning, including speed, while also providing the consistency and predictability of conventional records,” Crockett said. “Additionally, since it doubles as a physical jig, it can act as a verification device to confirm passivity on an analog patty cast prior to the delivery appointment, and the linked scan bodies can be scanned extraorally in a desktop scanner for improved accuracy.”
This ability to incorporate a desktop scanner is one of the key differences between the Optisplint and other available intraoral full-arch systems on the market, such as ioConnect ™ (TruAbutment), which attempts to reduce stitching errors by shortening the dental arch. Other new products that attempt to improve intraoral scan quality include the Nexus iOS (powered by Osteon), EZ Ref (Evolve), Grammetry ArchBridge™ (Roe Dental), Scan Ladder and TRI® Scanbridge. However, as more studies testing these newer products are performed, we will be able to better gauge their efficacy in our practices for full-arch prostheses.
Clinical and Practice Management Implications
Two of the biggest trends in dentistry are an increase in the number of patients and a simultaneous decrease in the number of dental laboratory technicians. This combination has resulted in an increased burden on dental labs with respect to keeping up with the growing demand and subsequently higher lab bills for the dentist. So, what are some of the ramifications of this newer technology in the dental world?
By making the final impression process for multiunit implant prostheses more efficient by reducing chair time and
simplifying the steps needed, PG allows more general dentists to take on a larger number of full-arch implant cases that might have otherwise been referred out to specialists. Additionally, this technology can be cost effective for those who perform a high volume of implant restorations (both for provisionals after surgery and for final restorations) or for dentists who want to try to keep more lab work in-house to save on lab fees.
One consequence of PG is that its workflow is model-less, which can be a negative because there is no verified master cast on which titanium bases can be cemented or the passivity of the prostheses checked in advance. As a result, alternative solutions like the Optisplint have become increasingly popular, and more and more full-arch implant prostheses are now being printed or milled directly to the multiunit abutments with special screws that bypass the need for titanium bases. The number and variety of these “direct to multiunit abutment screws” are growing to meet the demand. Some examples of these include the DESS Full Arch Multiunit, Rosen, Vortex, SIN Screws and Powerball screws.
However, “while we routinely use these screws for surgical interims and prototypes, we have seen countless instances in the literature of an increased risk of zirconia being damaged over time when it interfaces directly with metal (i.e., zirconia abutments connected to titanium implants), so we do not like to use these screws for our final implant prostheses,” Farley said. “Instead, we use either titanium bases for a monolithic zirconia prosthesis or, our preference, a titanium bar with a monolithic zirconia sleeve cemented on top.”
Looking Toward the Future: The Digital Advantage
Regardless of the mode of impressionmaking, dentists must go to great lengths to accurately capture implant positions to better ensure the passive fit of implantsupported prostheses. This is because a lack of passive fit can introduce stress into the restoration and surrounding implants, resulting in increased risk for mechanical
and biological complications such as bone resorption and screw-loosening, both of which can contribute to prosthetic failure. 3,12 While many studies support the accuracy of PG as a valid method of recording intraoral implant positions, we still need to use our best clinical judgment when evaluating the scope of dental literature as to when it would be fitting to harness this technique for our own cases.
“It is important that people don’t choose all-on-X because it is easier, but rather because it is the best treatment solution for the patient’s specific biology,” Schlam said. “Dentists should be careful not to treatment-plan full-arch implantsupported prostheses based solely off clinician preference but instead decide to do these cases according to what is best for the patient. It is our duty to educate patients about the pros and cons of all treatment options because implants are not without complications.”
If we do decide that implants are indicated, studies have shown that decreasing the number of procedural steps with CAD/CAM technology can increase the precision and survival of the implant prosthesis.13 By leveraging the digital technology at our fingertips, not only can we be more efficient and profitable chairside, but our patients can be more comfortable, our workflows less complicated and our confidence levels maximized. ♦
Leila Zadeh, DMD, FAGD, is an advanced restorative dentist at digitalDDS and an adjunct assistant professor at NYU Langone Health’s advanced education in general dentistry residency. She also creates educational content for Spear Education.
Zadeh is employed by digitalDDS, a prosthodontic continuing education platform that specializes in digital workflows, including Exocad, Meshmixer and Blue Sky Bio Software instruction. Zadeh reports no conflicts of interest pertaining to this topic. To comment on this article, email impact@agd.org
References
1. “Facts & Figures.” American College of Prosthodontists, gotoapro. org/facts-figures/. Accessed 4 Sept. 2024.
2. Joensahakij, Nitchakul, et al. “The Accuracy of Conventional Versus Digital (Intraoral Scanner or Photogrammetry) Impression Techniques in Full-Arch Implant-Supported Prostheses: A Systematic Review.” Evidence-Based Dentistry, vol. 25, no. 4, 2024, pp. 216-217.
4. Revilla-León, Marta, et al. “Comparison of Conventional, Photogrammetry, and Intraoral Scanning Accuracy of Complete-Arch Implant Impression Procedures Evaluated with a Coordinate Measuring Machine.” The Journal of Prosthetic Dentistry, vol. 125, no. 3, 2021, pp. 470-478.
5. Tohme, Hani, et al. “Accuracy of Implant Level Intraoral Scanning and Photogrammetry Impression Techniques in a Complete Arch with Angled and Parallel Implants: An In Vitro Study.” Applied Sciences, vol. 11, no. 21, 2021, p. 9859.
6. Jemt, Torsten, and Anders Lie. “Accuracy of Implant-Supported Prostheses in the Edentulous Jaw. Analysis of Precision of Fit between Cast Gold-Alloy Frameworks and Master Casts by Means of a Three-Dimensional Photogrammetric Technique.” Clinical Oral Implants Research, vol. 6, no. 3, 1995, pp. 172-180.
7. Jemt, Torsten, et al. “Photogrammetry: An Alternative to Conventional Impressions in Implant Dentistry? A Clinical Pilot Study.” The International Journal of Prosthodontics, vol. 12, no. 4, 1999, pp. 363-368.
8. Iturrate, Mikel, et al. “Accuracy of Digital Impressions for Implant–Supported Complete–Arch Prosthesis, Using an Auxiliary Geometry Part—An In Vitro Study.” Clinical Oral Implants Research, vol. 30, no. 12, 2019, pp. 1250-1258.
9. Pradíes, Guillermo, et al. “Using Stereophotogrammetric Technology for Obtaining Intraoral Digital Impressions of Implants.” The Journal of the American Dental Association, vol. 145, no. 4, 2014, pp. 338-344.
10. Gómez–Polo, Miguel, et al. “Accuracy, Scanning Time, and Patient Satisfaction of Stereophotogrammetry Systems for Acquiring 3D Dental Implant Positions: A Systematic Review.” Journal of Prosthodontics: Official Journal of the American College of Prosthodontists, vol. 32, suppl. 2, 2023, pp. 208-224.
11. Hussein, Mostafa Omran. “Photogrammetry Technology in Implant Dentistry: A Systematic Review.” The Journal of Prosthetic Dentistry, vol. 130, no. 3, 2023, pp. 318-326.
12. Kosago, Pitchaporn, et al. “Comparison of the Accuracy between Conventional and Various Digital Implant Impressions for an Implant–Supported Mandibular Complete Arch–Fixed Prosthesis: An in Vitro Study.” Journal of Prosthodontics: Official Journal of the American College of Prosthodontists, vol. 32, no. 7, 2023, pp. 616-624.
13. Peñarrocha-Diago, María, et al. “A Combined Digital and Stereophotogrammetric Technique for Rehabilitation with Immediate Loading of Complete-Arch, Implant-Supported Prostheses: A Randomized Controlled Pilot Clinical Trial.” The Journal of Prosthetic Dentistry, vol. 118, no. 5, 2017, pp. 596-603.
14. Bergin, Junping Ma, et al. “An in Vitro Comparison of Photogrammetric and Conventional Complete-Arch Implant Impression Techniques.” The Journal of Prosthetic Dentistry, vol. 110, no. 4, 2013, pp. 243-251.
15. Zhang, Yi-Jie, et al. “Accuracy of Photogrammetric Imaging Versus Conventional Impressions for Complete Arch Implant-Supported Fixed Dental Prostheses: A Comparative Clinical Study.” The Journal of Prosthetic Dentistry, vol. 130, no. 2, 2023, pp. 212-218.
16. Tohme, Hani, et al. “Comparison Between Stereophotogrammetric, Digital, and Conventional Impression Techniques in Implant-Supported Fixed Complete Arch Prostheses: An In Vitro Study.” The Journal of Prosthetic Dentistry, vol. 129, no. 2, 2023, pp. 354-362.
17. Revilla-León, Marta, et al. “Trueness and Precision of CompleteArch Photogrammetry Implant Scanning Assessed with a Coordinate-Measuring Machine.” The Journal of Prosthetic Dentistry, vol. 129, no. 1, 2023, pp. 160-165.
3. Ma, Bowen, et al. “Accuracy of Photogrammetry, Intraoral Scanning, and Conventional Impression Techniques for Complete-Arch Implant Rehabilitation: An In Vitro Comparative study.” BMC Oral Health, vol. 21, no. 1, 2021, p. 636.
Self-Instruction
Implants
Subject Code: 690
The 10 questions for this exercise are based on information presented in the article, “Navigating Implant Success with Photogrammetry: The How, When and Why” by Leila Zadeh, DMD, FAGD, on pages 10–15. This exercise was developed by members of the AGD editorial team.
Reading the article and successfully completing the exercise will enable you to:
• understand what photogrammetry (PG) technology is;
• explore how PG technology can help streamline the final implant impression process for multiunit implant prostheses; and
• evaluate the scientific basis and validity of currently available clinical studies using PG technology.
This exercise can be purchased and answers submitted online at agd.org/selfinstruction
Answers for this exercise must be received by April 30, 2028.
1. In the United States, more than _____ million people are completely edentulous, and approximately _____ million people are missing at least one tooth.
A. 38; 100
B. 37; 110
C. 36; 120
D. 35; 130
2. Photogrammetry (PG) is a _____.
A. type of radiography that obtains 3D images
B. cephalometric method of analyzing 3D CBCT scans
C. method of making precise measurements by using reference points in radiographs
D. method of approximating the 3D orientation of objects using 2D images
3. First used in implant dentistry as early as the mid-1990s, PG was proposed as an alternative to conventional full-arch implantsupported impressions by Torsten Jemt et al. in _____.
A. 1997
B. 1998
C. 1999
D. 2000
4. All of the following are reasons why PG scanners do not have the same stitching errors as intraoral scanners except one. Which is the exception?
A. All of the scan body data is captured at once with each picture.
B. PG scanners have a larger amount of random access memory than intraoral scanners.
C. The multiple cameras of a PG unit have a larger scanning range and faster scanning speed.
D. PG units’ accuracy is not as influenced by patient movement or by blood, saliva and other residue.
5. PG can streamline and simplify the full-arch final impression process chairside to a mere _____ minutes.
A. 15
B. 30
C. 45
D. 60
6. If your budget is $20,000 for a PG unit, which of the following units should you purchase?
A. Grammee
B. iCam4D
C. PIC
D. MicronMapper
7. The information generated by a PG unit is stored as an STL file, which stands for _____ file.
A. single-terraced latency
B. simulated time layer
C. semi-transmuted linear
D. standard tessellation language
8. One important factor to consider when assessing the validity and applicability of existing studies on the accuracy of PG units is that the “design, wear, or _____ of the PG markers” could potentially affect the accuracy.
A. number
B. angulation
C. torque displacement
D. age
9. All of the following are downsides of PG except one. Which is the exception?
A. model-less workflow
B. scan bodies are single-use
C. still requires an intraoral scanner
D. high cost
10. All of the following are direct to multiunit abutment screws except one. Which is the exception?
A. Powerball
B. Vortex
C. CON Screws
D. Rosen
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What Makes a New Graduate Employable?
By Brooklyn Janes
Many of my classmates and colleagues are currently interviewing for job opportunities, and some have already signed contracts with companies across the country — months before graduation. As we approach the finish line of dental school, our minds as fourth-year students are shifting into “work mode,” thinking about the realities of postgraduation life. This transition has made me reflect on what I want as I start my career, what I imagine my first job to be like, and the kind of clinician and provider I hope to become. But first — what are hiring managers even looking for in a new graduate?
I remember how challenging my first year as a dental hygienist was. In hygiene school, I saw just one patient in the morning and one in the afternoon. But, in private practice, I was suddenly expected to see 8–10 patients a day. I felt like I was constantly behind, struggling to keep up, and I spent hours catching up on notes after work. A mentor once told me, “Things will eventually slow down for you as you become more comfortable and efficient in your work.” At the time, I didn’t fully understand what he meant, but now I do. What once took me three hours in hygiene school, I can now accomplish in an hour.
Because of that experience, I can only imagine that being a new dentist will be even more stressful. I often wonder if I will ever be able to work at the level of the experienced doctors I’ve learned from. Will I be able to keep up with the demands of private practice? I know my slowness as a new hygienist once cost me job opportunities, so I can’t help but ask myself: What will hiring managers think of me if I’m not as fast as other dentists? Am I even employable?
These doubts and insecurities make me uncomfortable, but I also know that if I went straight into private practice, I would eventually figure things out. However, for me, I want to do more than just “figure it out.” I want to be overly prepared. I want to be the doctor who doesn’t have to rely on others to get through that first year of uncertainty. I want to be ready to hit the ground running. That’s why I’m excited to pursue an advanced education in general dentistry (AEGD) residency at Roseman University through NYU Langone starting in July. I truly believe this experience will make me more employable and better equipped for the challenges ahead.
Employment Qualifications
According to Dr. Gervasi I wanted to hear from those who have already navigated the challenges of transitioning from school to practice. What do experienced dentists believe makes a new graduate employable? I spoke with two doctors who have been through this journey themselves. Their perspectives offered valuable advice on what employers look for in a young dentist — and how we, as new graduates, can set ourselves up for success.
One of those doctors is John Gervasi, DDS, a 2021 graduate of the University of Detroit Mercy and an alumnus of NYU Langone’s AEGD residency at Roseman University. Gervasi emphasized the value of pursuing a residency, particularly one that differs from dental school. He advised graduates to seek programs that expose them to new skills and treatment procedures. “A program that challenges you and pushes you beyond your comfort zone is imperative,” he said.
Gervasi believes employers expect new graduates to join a practice with a strong foundation. “A residency helps build that foundation in dentistry by connecting the dots between simple and difficult cases,” he said. “Unless you’re being mentored by a family member or close friend, it’s difficult to bridge everything together at your own pace and make sense of complex cases.” However, he clarified that success without a residency is possible — it depends on several factors. When joining a practice straight out of dental school, mentorship can vary widely. “One needs to consider how both parties — the new grad and the owner — define mentorship,” he said. He elaborated that a patient mentor will help a new dentist develop treatment plans that meet realistic patient demands. “Treatment-planning is your blueprint before touching any instruments or drills,” he added.
Gervasi shared an example of treatment-planning for a partial denture, emphasizing the importance of keeping the end result in mind — deciding which teeth to preserve as abutments and which to extract to ensure the partial’s success. Factors like bone loss, periodontal health and finances also come into play. “Treatmentplanning for complex cases involves many variables, and, without a solid foundation, it can be a real challenge,” he said. “A residency program gives you the experience to handle these complexities with confidence. Think of it like having personal trainers in a gym — they push you to the next level by sharing their skills and knowledge.” He explained that he valued his residency experience because the mentors understood his starting point and where he needed to be by the end of the program. They recognized his strengths and weaknesses, oversaw his cases, questioned his reasoning for treatment decisions and evaluated his clinical skills. “Can you get all of that from mentorship straight out of school?” he asked.
He also shared a useful tip for job interviews: “Ask, ‘What does mentorship look like to you?’” This question helps gauge whether the potential mentorship aligns with your needs. Are you someone who just needs reassurance after a quick glance at a radiograph, or do you require step-by-step explanations and demonstrations?
Understanding these things about yourself before you begin interviewing can help you assess whether a practice is the right learning environment for you. “You also don’t know how patient your mentor will be when days get busy and stressful,” he added.
Gervasi also highlighted the importance of speed and quality. “Speed is important for new graduates, and, if I were hiring someone fresh out of school, I’d consider it a measure of efficiency. Speed comes with time, but quality matters most,” he said. “Quality work builds trust with patients.” He encourages new dentists to be up front about procedure times. For example, you might say, “I’d like to do this as efficiently as possible for you, but I also want to ensure a successful outcome, so please be prepared to spend an hour or two with me.”
He acknowledged that extended procedure times, like threehour molar root canals, are common in dental school but not practical in private practice. “Patients expect procedures to be done in a timely manner,” he said. “This is another reason why a residency is beneficial — it helps build a strong foundation and prepares you to work more efficiently. You find a comfortable pace for yourself.” In his opinion, residents are years ahead of where they would be if they went straight into practice. He pointed out that owner-doctors are unlikely to assign large cases to new graduates who take too long to complete them. Many new dentists switch jobs within their first year or two — or return to residency — because they lack the experience to handle complex cases. “Residencies provide built-in mentorship that not only enhances your skill set but also improves your efficiency,” he said.
When searching for a job, Gervasi advises new graduates to consider what they bring to the table, their skills and their comfort levels. During his residency, he completed around 100 root canals, which gave him confidence in endodontics. Since he wanted to include endodontics in his daily work, he avoided practices that mostly referred those cases out.
Gervasi urged graduates to be realistic — not just about their speed and abilities, but also about their income expectations. He advises steering clear of quota-driven offices, where meeting numbers can compromise the quality of care. “Every patient and case is different. Some patients don’t respond well to local anesthetics, and some need breaks during treatment. Patients want to be treated as individuals, not numbers,” he said. “I chose my current office because they allow me to treat patients the way I see fit, without being driven by quotas or insurance metrics.”
Something not always taught in dental school, Gervasi noted, is how to interact with patients, colleagues and staff professionally. “An employable new graduate should be professional, teachable and willing to listen from others,” he said. “Patient management is a completely different tier of dentistry. You may know how to do that restoration, but, if you can’t make your patient comfortable in the chair, that’s a problem.”
Finally, Gervasi encouraged new dentists to stay humble and appreciate both the good and challenging days. “Keep your heart in dentistry, because that’s what will carry you through,” he said. “I hope that each new grad finds their path in a healthy environment after dental school. And I hope every owner looking for a new associate finds someone who is teachable and works hard to help build their practice.”
What Dr. Neilson Looks For in Hires
I also had the privilege of speaking with Chris Neilson, DDS, who has owned Bloomington Dental in Southern Utah for over 25 years, to get his perspective on what makes a new dental graduate employable. As a practice owner, what qualities does he look for? What are the red flags that might make him hesitate to hire someone?
For Neilson, one of the biggest red flags is poor communication. He wants an associate who can clearly explain a patient’s oral condition in a way that’s easy to understand and who can empathize with the patient. “Dentistry can be intimidating and scary for the general public,” Neilson said. “You can’t just walk into an exam, plan a few fillings, and say, ‘Thank you for stopping by.’” He emphasized that most patients need more than just a quick explanation — they need to be shown what’s going on with their teeth. Radiographs, intraoral pictures, 3D scans and CBCT images are great tools to help illustrate the issue. If you can walk the patient through their treatment options and help them understand their needs, you’re more likely to get treatment acceptance. Strong communication and teaching skills, he stressed, are the foundation of a successful practice.
Another red flag for Neilson is a lack of enthusiasm. “I want someone who’s excited to be here and helps make the environment enjoyable,” he said. Negativity and constant complaints don’t contribute to a healthy and happy work atmosphere. In fact, Neilson would hire someone with a great attitude even over someone with years of experience. “I’d rather hire someone with a ‘will-do’ attitude — someone dependable, professional and willing to stay until the job is done — than someone with years of experience but a poor work ethic and bad attitude.”
Arrogance is another deal-breaker. Neilson believes dentistry is always evolving, and he wants someone who’s adaptable and open to learning. While he welcomes new techniques and materials, he’s wary of hiring someone who dismisses his way of doing things. “I wouldn’t hire someone who comes in acting like
they already know everything or tells me I’m doing things the ‘old way,’” he said. Instead, he looks for people who are teachable, adaptable and eager to grow.
Neilson also described his practice as highly specialized, with a strong focus on quality over quantity. “I don’t run a revolvingdoor practice where patients are rushed in and out. I take my time because I care about the quality of my work,” he explained. “I’ve invested in many advancements and technologies to better serve my niche patient population. I take pride in my artistry and absolutely love what I do. When hiring a new graduate, I’m looking for someone who would be a good fit for our practice culture.”
One practical tip he shared for new graduates was to create a professional portfolio to bring to job interviews. “I’d love to see what you can do. Show me a picture of your best work,” he said. Even something as simple as a well-executed root canal can demonstrate attention to detail, proficiency with an intraoral camera and pride in your work. “A portfolio speaks volumes. It tells me you care about your craft and take your work seriously,” he said. His advice: Start building a portfolio early — it could make all the difference in landing the right job.
On to the Next Big Thing
After speaking with both Gervasi and Neilson, I felt even more excited about my decision to pursue an AEGD residency. I was also surprised at the crucial roles that personality and attitude play in hiring new graduates. It made me realize that maybe we put too much pressure on ourselves to have all the technical skills figured out before landing a job. What really stands out to these doctors is a willingness to learn with humility. That’s what truly leads to success in securing that first job right out of dental school.
I was also surprised that neither of them mentioned the need for leadership experience, extracurricular activities or research. While these are valuable traits that can enhance your CV and showcase your character, it seems that enthusiasm, communication and a positive attitude are the real differentiators.
Congratulations to the class of 2025! I wish you all the best in your next adventure. We did it! ♦
Brooklyn Janes is a fourth-year dental student and AGD chapter president at Roseman University College of Dental Medicine. She is also the AGD Impact Student Perspectives columnist. To comment on this article, email impact@agd.org
Testing the Tools
By Ross Isbell, DMD, MBActice,
my usual plan is to extract a tooth as atraumatically as possible and allow the site to heal. This is the least expensive treatment, and we know the body will heal in time. However, I am not always fortunate enough to have patients or sites that heal perfectly — luckily, there are a variety of ways to help heal them. While postoperative management of surgical sites is a commonly encountered situation in practices that extract teeth, past solutions haven’t always been as predictable
A Clear Choice for Matrix Systems
Bioclear Matrix HD Anterior Kit
Bioclear bioclearmatrix.com
One of my least favorite things to hear from a new patient with a broken tooth is, “Can’t you just throw some bondo on there?” They want a quick fix with a high esthetic demand. I pride myself on being a pretty good freehand composite sculptor, but not every situation is simple, and it’s always nice to have a guide. For Class IV restorations, composite veneers and space closures, a quick-and-easy way to build an idealized contact, contour and emergence profile with minimal effort is the Bioclear Matrix system. As the only fully clear sectional matrix system, it makes it simple to cure while creating an interproximal restructuring result that doesn’t require a lot of cleanup. There are a variety of matrices available in Bioclear’s catalog, so it makes sense to get a sampler kit and enable selection of the perfect fit for the spaces you are presented with. I primarily use the heavy duty (HD) anterior set, but the diastema set is also nice to have on hand because it has more curvature and is better for filling large spaces. The HD line utilizes a thicker mylar than the original line for a more rigid shell and easier placement. Bioclear Matrices are tooth- and spacespecific; while you can buy individual refill sets of 25 for about $50, I would recommend buying the entire kit for $329 from the start. After you have chosen the matrix that fits your space needs best, take time to customize the matrices to fit the shape and depth of the papilla and bone in the interproximal zones you plan to restore. Bioclear recommends using scissors, but I typically prefer using a fine diamond bur and a brownie because I can round and polish more quickly. Once the tissue region of the matrices is correct, they can be inserted firmly into the sulcus, which will stabilize them and hold them in place for you through the rest of the procedure while also creating a smooth marginal seal without needing a wedge in most situations. If you are having trouble sliding the matrix through a contact, you can either wedge the teeth temporarily to open and pass the contact, or you can use an interproximal reduction or polishing system to open the contact slightly. When you are filling spaces like black triangles, where the contact is small and does not need to be broken, the contact is a great additional stabilizer. Once the matrix is in place, follow your typical etch, bonding and injection of composite process to build out your edge. On average, these matrices will cost you a little less than $2 each but will save you a tremendous amount of time for a really nice finish with anterior composite rebuilds.
I Spy the EyeSpecial
EyeSpecial C-V
Shofu
shofu.com
Clinical photography is continuing to become more and more important in dentistry as the public expects us to be able to create and market a digital portfolio of our work. I do not claim to be a photographer, but I do want my team to be able to quickly take appropriate and beautiful pictures. Enter the EyeSpecial C-V from Shofu. This camera has been refined over five generations to become the perfect dental camera. With 10 light sources from multiple angles and an easily adapted focal range based on which mode you choose, this is a point-and-shoot success story that anyone can use to take the right shot. My team almost exclusively uses Face and Standard modes, but, for smaller sites, I like how the Surgery mode zooms in and captures quadrantsized spaces. In this model, Shofu also upgraded the hardware and software to make it WiFi capable, so you can send your images directly to your local cloud storage folder. We operate the camera almost entirely through the large rear touchscreen, though there are physical buttons as well. The screen is crucial because, in the age of smartphones, everyone needs the ability to instantly review their results. The chassis is smooth and designed to be wiped between cases, so this can be used with gloves midcase if needed. At 12 megapixels with a 49-millimeter lens, the camera will provide effortless high-quality photos, making it a worthwhile upgrade over any smartphone.
Ross Isbell, DMD, MBA, currently practices in Gadsden, Alabama, with his father, Gordon Isbell, DMD, MAGD. He attended the University of Alabama at Birmingham (UAB) School of Dentistry and completed a general practice residency at UAB Hospital. Isbell has confirmed to AGD that he has not received any remuneration from the manufacturers of the products reviewed or their affiliates for the past three years. All reviews are the opinions of the author and are not shared or endorsed by AGD Impact or AGD. To comment on this article, email impact@agd.org
Cement This Cement’s Spot in Your Delivery Process
GC FujiCEM® Evolve
GC
gc.dental
When choosing cements for fixed restorations, I usually prefer a true resin for flexural and bond strength reasons. However, in some oral environments it is just as important, or more so, to promote bioactivity. With GC FujiCEM® Evolve, I feel like I have found something that can do both. This material is a resinreinforced glass ionomer (GI) cement, so it has many of the properties and handling characteristics of a resin cement, such as light-curing capabilities and bond strength, while maintaining the fluoride-releasing properties of a standard glass ionomer. Resin-reinforced (compared with resin-modified) means that enough of the material is resin that its structural properties have been altered. It functions well with a variety of substrates, though I primarily use it for zirconia in the posterior. This is a great medium for higher caries-risk patients. Unlike many glass ionomer luting cements that are chemically set, FujiCEM Evolve can be tack-cured and cleaned up significantly quicker. If you choose not to tack-cure and immediately begin cleaning up, it will reach a gel-like state that peels off margins easily in about three minutes. As a GI-type cement with strontium glass filler particles, it is more moisture-tolerant than a true resin and is effective at recharging with alkaline ions such as fluoride when it is bioavailable. The material comes in a seemingly traditional FujiCEM wide double-barrel configuration to still allow an easy option for self-mixing, but it also includes a proprietary automix tip that accompanies the syringe. This tip is not a standard universal twist type, but instead has a clip-lock mechanism. While I personally don’t choose to self-mix and prefer the automix, it is nice that the delivery system allows for user choice. This modern version of a classic deserves a spot in your delivery process.
In the June issue of AGD Impact :
• Regenerative Dentistry
• Dental and Dental Hygiene Compacts
In the May/June 2025 issue of AGD’s peer-reviewed journal, General Dentistry :
Rare angiofibrolipoma of oral cavity: a case report
Angiofibrolipomas are one of the rarest variants of lipoma, a benign mesenchymal tumor composed of adipose tissue. Histologic examination of angiofibrolipomas reveals mature adipocytes, vascular tissue, and fibrous connective tissue. This case report describes an angiofibrolipoma in the oral cavity of a 40-yearold woman. A soft, painless, pedunculated mass was attached to the distolingual gingiva in the region of the mandibular third molar. The provisional diagnosis was pyogenic granuloma. The mass was excised using electrocautery, and the tissue was submitted for histologic examination. Histologic staining revealed mature adipose tissue, fibrous tissue, and numerous small blood vessels, consistent with a diagnosis of angiofibrolipoma. Further immunohistochemical analysis with CD34 biomarker was performed to rule out spindle cell carcinoma. At the 1-year follow-up examination, no recurrence was found. However, due to the rarity of these tumors, more data are needed to determine their recurrence rate.
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