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Page 1

SEPTEMBER 2015

MEET

AUTUMN more on Page 30

weighing the evidence A guide to evaluating pediatric Zirconia crowns.

When it becomes personal ONE MOM’S PERSONAL EXPERIENCE WALKING IN HER PATIENTS’ SHOES.

BREAKING

barriers more on Page 22


COURSE DESTINATIONS FOR 2016

Sydney AU 1/22

Salt Lake City 2/5

Philadelphia 3/11

Orange County 4/1


EZPU EZPEDO UNIVERSITY

EST. 2013

Dallas 4/15

Seattle 8/5

Miami 12/2


Table Of Contents

10 WHEN IT BE COM E S P E RS ONAL How one mom’s personal experience forced her as a professional to walk in her patients’ shoes.

18 ON T H E C UT T I NG ED G E UNLV prepares its residents for a rapidly changing world.

30 M E E T AUT UMN She’s so much more than just a pretty smile.


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TABLE OF CONTENTS —

A R E YOU M IS S I NG THE BOAT?

Pages 10–13 W H E N I T B E CO M E S P E R S O N A L B Y J O E L L E S P E E D, D D S

Today’s modern parents

How one mom’s personal experience forced her as a professional

are interested in esthetics and

to walk in her patients’ shoes.

are willing to go the extra mile

Pages 15–17

to find an office that will provide it.

A R E YO U M I S S I N G T H E B O AT ? B Y V E R O N I C A – A N G E LO ’ S M O M Today’s modern parents are interested in esthetics and are willing to go the extra mile to find an office that will provide it.

Pages 18–21 ON THE CUT TING EDGE B Y A R L E N E J OY N E R , D D S UNLV prepares its residents for a rapidly changing world.

40 A LO OK BAC K

Pages 22–27 BREAKING BARRIERS BY NEIDRE BANAKUS, DDS The world’s first 20-unit pediatric Zirconia crown case.

Pages 28–29 MOMMY’S LIT TLE GIRL

How what I did in

B Y M E L L I S A – M A R YC L A I R E ’ S M O M

residency shapes

A 20-unit Zirconia crown case from a mom’s point of view.

what I do in private practice.

Pages 30–35 M E E T AU T U M N

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B Y J E F F R E Y F I S H E R , D D S & V I C TO R I A S U L L I VA N , D D S She’s so much more than just a pretty smile.

Pages 36–38 WEIGHING THE EVIDENCE

WHE R E WE ’ VE B EE N & WHE RE WE ’ R E GOING

BY JOHN HANSEN, DDS A guide to evaluating pediatric Zirconia crowns.

Pages 40–43

EZPEDO’s founders reflect on their journey and why after five

A LO O K B AC K

years they’re only

EZPEDO MAGAZINE INTERVIEWS DUSTIN JANSSEN, DDS

getting started.

Pages 44–53 WHERE WE’VE BEEN & WHERE WE’RE GOING BY JARED Y T TRUP EZPEDO’s founders reflect on their journey and why after five years they’re only getting started.

22 B R EA KI NG BA R R I ER S The world’s first 20-unit pediatric Zirconia crown case.


Contributors Joelle Speed, DDS

Dustin Janssen, DDS

Dr. Joelle Speed is a premier pediatric dentist and the owner of The Smile Gallery located in Roseville, California. She completed dental school and her pediatric residency at Loma Linda University School of Dentistry where she graduated with honors. Dr. Speed lives in Granite Bay, California with her husband and two beautiful girls.

Dr. Dustin Janssen received his DDS degree from Texas A&M University Baylor College of Dentistry and completed his training in pediatric dentistry at the University of Washington. Married with two beautiful children, Dr. Janssen is currently in private practice in Lubbock, Texas.

Neidre Banakus, DDS

John Hansen, DDS

Dr. Neidre Banakus received her dental degree from West Virginia University School of Dentistry. After dental school, Dr. Banakus completed a general practice residency at Lutheran’s Hospital in Brooklyn, New York and later completed her pediatric dental residency at the University of Kentucky in Lexington. Currently in private practice in Navato, California, she and her husband are expecting a new addition to their family any day now.

Dr. John Hansen has been a clinical instructor at Aesthetic Advantage (NYC, London, and Palm Beach, Florida) and an instructor at The California Center for Advanced Dental Studies. He is also a Life Clinical Instructor at the Kois Center, Seattle, Washington. Currently he maintains a private cosmetic dental practice in Roseville, California.

Jeffrey Fisher, DDS

Victoria Sullivan, DDS

Dr. Jeffrey Fisher is a graduate of Loma Linda University School of Dentistry and completed a dental anesthesia residency in 2001. Currently he provides office-based general anesthesia for pediatric dentists throughout the greater Sacramento area and inland valleys of central California.

Dr. Victoria Sullivan is a pediatric dentist practicing in El Dorado Hills, California. She graduated in 1995 from UOP and in 1997 from USC with pediatric certification. She has two children and is pursuing a masters degree in cognition and education from Rutgers University.

Arlene Joyner, DDS Dr. Arlene Joyner completed her residency in pediatric dentistry at the University of California Los Angles. She is currently in private practice in Hawthorne, California and is an associate professor of pediatric dentistry at the School of Dental Medicine, University of Nevada Las Vegas.

Jared Yttrup Jared Yttrup worked several years for nonprofit organizations, writing, editing and handling event planning. He holds a bachelor of arts degree in English from William Jessup University and is a feature writer for this issue.

Mellissa – Maryclaire’s mom

Veronica – Angelo’s mom

Mellissa wrote “Mommy’s Little Girl,” a continuation of our feature article showcasing the world’s first 20-unit pediatric Zirconia crown case.

Veronica wrote “Are You Missing the Boat?” to share her personal experience in finding a pediatric dentist that was willing to finally listen to what was important to her as a mom.


CONTACT US EZPEDO MAGAZINE Vol. 1 No. 2 September 2015

PUBLISHER EZPEDO, Inc. A:

6140 Horseshoe Bar Road, Suite L

Loomis, CA 95650

P:

+1 (888) 539 7336

INT:

+1 (916) 677 1447

E:

info@ezpedo.com

W:

www.ezpedo.com

M A G A Z I N E S TA F F JEFFREY FISHER, DDS Editor-in-Chief JAMES FISHER, MSPH, PhD Senior Consulting Editor ANN FISHER Copy Editor VLADIMIR SHCHERBAK Creative Director D A N N Y VA K A R Y U K Digital Edition Manager T I M OT H Y S H A M B R A

WELCOME Anyone who owns a dental practice knows that public perception is extremely important. After all, haven’t we all found that personal referrals are the most valuable factor in building a thriving and growing practice? In this day of Yelp reviews and Facebook posts, more people are exercising their option to compare and shop for what they

Senior Designer

C O N T R I B U TO R S Joelle Speed, DDS Dustin Janssen, DDS Neidre Banakus, DDS

perceive as the best place to seek dental treatment. Chair-side manner and the way we listen to our patients’ concerns and

John Hansen, DDS

desires are more important today than ever before. Facing this changing landscape, pediatric dentists confront a crucial choice:

Victoria Sullivan, DDS

stay with the status quo and risk becoming mediocre, or move ahead by adopting new strategies designed to set your practice

Arlene Joyner, DDS

apart by providing elite-level service. One of our goals at EZPEDO MAGAZINE is to share with you, our readers, the unique background stories of patients whose smiles

Jared Yttrup – Feature writer Mellissa – Maryclaire’s mom Veronica – Angelo’s mom

have been restored with EZPEDO crowns. Whether you see these smiles in a journal advertisement or supersized on a wall at our AAPD annual meeting booth, or in one of our YouTube videos, every child we feature displays an EZPEDO smile and enjoys a unique experience we intend to share.

We are confident that you,too, will be inspired... As a dentist anesthesiologist, I have had the personal honor of providing anesthesia for many of the children we featured this year. My job is both challenging and rewarding, but seeing firsthand the expressions of joy and relief on the faces of parents as

D I G I TA L E D I T I O N www.ezpedo.com/publications For new subscriptions, subscribe at ezpedo.com For all other reader services, including letters to the editor, write to info@ezpedo.com

they view their little princess (or prince) for the first time with an EZPEDO-restored smile is truly the most fulfilling part of my job. This month marks the five-year anniversary of EZPEDO’s public debut. These five years have truly been a wild ride, but one that I would not have traded for the world. Both John and I thank you for your continued faith and trust in EZPEDO. Based on your feedback, we have continued to improve our product, making our crowns easier and faster to seat than ever before while maintaining the high-quality esthetic standards you have come to expect. As a dentist-owned company, we are passionate about esthetics. We manufacture our crowns motivated by a desire to fuel that same passion in our fellow dentists. And we take great pride that our customers—and their patients—are enthusiastically sharing the word about EZPEDO. As this good news spreads, these beautiful, hand-crafted crowns have gained a reputation as the world’s #1 esthetic pediatric Zirconia crown.

Jeffery Fisher, DDS Editor-in-Chief


Our crowns. Her smile.

EZPEDO is proud to show you the actual EZPEDO smiles of the children have worked with. A NNUAwe L S YMPOSIUM So remember, if youSummer see them in our ads 2016 it’s because they’re our patients.

Aspire to be your very best. ezpedo.com


EZPEDO ACTUAL EZPEDO PATIENT


IN PRIVATE PRACTICE / PERSONAL IN PRIVATE PRACTICE / PERSONAL

FOUR YEARS LATER When it finally exfoliated, four years after it was cemented, Cambria’s crown looked as good as the day it was placed.

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When it becomes personal by Joelle Speed, DDS

How one mom’s personal experience forced her as a professional to walk in her patients’ shoes. Being a mom has led me to become a better pediatric dentist. Before I had kids, dentistry was so black and white. I knew exactly what to tell my parents when they struggled with tooth brushing. I could instruct parents on what healthy snacks to give their children and how I would fix the cavities that undoubtedly would be diagnosed. My advice was really very textbook.

EZPEDO Magazine / September 2015

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Dr. Speed with daughter Cambria.

As I practiced longer, however, I began to make decisions for my practice that went against the “norm” in my profession. I found myself looking for alternatives that my parents were asking for and that some were even demanding. By alternatives, I’m talking about parents wanting more esthetic restoration options for their children. The standard treatments that I learned in school were amalgam fillings and stainless steel crowns. Well, I have since discovered that these options just weren’t cutting it anymore no matter what textbook explanation I might give—especially the use of stainless steel crowns. I remember years ago having a conversation with my dental anesthesiologist, Dr. Jeffrey Fisher, about this very topic. To know Dr. Fisher is to know that he has the mind of an inventor. So I said to him, “Hey, why don’t you develop a really good esthetic white crown for children?” Flash forward to the present, and that is exactly what he and Dr. John Hansen have done. Founded on their joint vision, EZPEDO was born, and the dream of esthetic pediatric crowns is now a reality. I think sometimes we as dentists, and subsequently as parents, discover that the dental challenges of our own children teach us valuable lessons and force us to learn and grow as practitioners. This is exactly what happened to me. I have two beautiful girls, and I brushed and flossed their teeth daily when they were little. Textbook, right? Well, my youngest daughter had a mouthful of issues. She had almost a complete anterior-posterior cross bite

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of the maxilla, an exceedingly small mouth, and an extreme gag reflex. Brushing, flossing, dental cleanings, and dental x-rays caused her extreme anxiety (and me, too). It was very difficult at best. So when she was 6 years old, she developed an inter-proximal cavity on #I—the unthinkable for a “mom” pediatric dentist. It was large by the time we found it because it was a visual discovery (Our bite wings were never great.). Now we were talking a pulpotomy and crown. How could this be? I admit it. As a mom, I did not want to put a stainless steel crown in her mouth. I was so grateful and happy to have the EZPEDO option available at that time nearly four years ago. The crowns were still new to me then, but I knew they were the best choice for my daughter. Of course the crown looked amazing when first seated and continued as a healthy, stable restoration throughout the life of the tooth. Just about three months ago, the crown exfoliated naturally on its own, just before her 10th birthday. Had I not lived this experience with my own daughter, I’m not sure that I would have the same depth of attachment that I have to these crowns. I can highly recommend EZPEDO crowns because it’s personal for me now. I followed that crown for nearly four years without a problem. And as a pediatric dentist and a mom, that kind of reliability and outcome means everything! 


I FOLLOWED THAT CROWN FOR NEARLY FOUR YEARS WITHOUT A PROBLEM. AND AS A PEDIATRIC DENTIST AND A MOM, THAT KIND OF RELIABILITY AND OUTCOME MEANS EVERYTHING! JOELLE SPEED, DDS

Thinking Back Dr. Speed and her daughter share their personal journey.


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EZPEDO Magazine / September 2015

STAY IN TOUCH TO BE THE FIRST TO KNOW ABOUT EZPEDO EVENTS, PROMO TIONS, AND OTHER VALUABLE EDUCATIONAL CONTENT. #EZPED O


PARENT’S POINT OF VIEW / THE SEARCH

Angelo and his mom, Veronica, sharing a happy moment.

Are You Missing The Boat? BY VERONICA – ANGELO’S MOM

Today’s modern parents are interested in esthetics and are willing to go the extra mile to find an office that will provide it.

N

othing can be more frustrating for a mom than experiencing a difficult time finding a dentist that will listen to her desires for her child. This exasperation is exactly what I experienced back in May when I was looking for a pediatric dentist that would place white crowns on my 3-year-old son, Angelo. I was first referred to a pediatric dentist that told me he did not recommend white crowns. This was due to the fact that young children tend to grind their teeth, which might, in his opinion, cause the crowns to crack. He wanted to use silver crowns. This was not the answer I wanted to hear. I absolutely did not want my son to have silver crowns! Silver crowns were outdated in my opinion, especially with how much dental technology has advanced in today’s world. I did not want my son to have a mouth full of silver. I stubbornly expressed my interest in white crowns and even offered to pay the difference of what my insurance wouldn’t cover. But this dentist kept referring to the common practice of using his old standard— silver crowns. Even the dental hygienist continued on about not recommending white crowns. As I thought of my son, I did not want the rest of the world knowing that, because of my failure to supervise his oral hygiene, he was now going to need multiple crowns. Silver crowns would make this obvious and I didn’t want this fact advertised, especially when his beautiful smile would never look the same, at least not until his adult teeth came in. I unhappily booked the appointment for his surgery and ended up leaving that first office with no information on a white crown option. Completely disappointed, I didn’t feel they were listening to me at all. EZPEDO Magazine / September 2015

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Even though I had already booked an appointment with the first dentist, I continued looking for other dentists who would give me more options. About a week later, I contacted another pediatric dentist who, unfortunately, also refused to recommend white crowns. None of the dentists were willing to offer me an alternative option to silver crowns. Finally, I had the good fortune to contact Rocklin Pediatric Dentistry. They gave me great information about EZPEDO crowns and explained how affordable they are. I was so excited that someone was finally giving me the information I needed to make an informed decision. I first received brief information about the crowns over the phone. Prompted by the office staff, I also did additional research on the EZPEDO Web site. The information I was able to obtain won me over. I learned that

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EZPEDO Magazine / September 2015

EZPEDO crowns are “virtually indestructible” and that they “look like natural teeth.” This is exactly what I was looking for. I was delighted to make the call and set up an appointment for my son to see Dr. Jessi. It’s now a month later, and my son’s teeth look amazing! Thank you to Dr. Jessi and her amazing staff at Rocklin Pediatric Dentistry. And thank you to Dr. Fisher who provided the anesthesia for the surgery and who, with Dr. Hansen, created the incredible esthetic white crowns used to restore Angelo’s beautiful smile. 


I WAS SO EXCITED THAT SOMEONE WAS FINALLY GIVING ME THE INFORMATION I NEEDED TO MAKE AN INFORMED DECISION.

Rocklin Pediatric Dentistry Makes a Difference

After reviewing radiographs and completing a thorough exam, it was clear that Angelo was a perfect candidate for both anterior and posterior EZPEDO crowns. We were happy to be able to accommodate Angelo’s mother’s wishes while providing a long-term, esthetic restoration for her son’s decayed teeth. Angelo’s crowns turned out beautifully and he and his mother are both thrilled with his new, healthy smile! Dr. Jessica Alt, DDS

EZPEDO Magazine / September 2015

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HIGHER EDUCATION / RESIDENCY

ON THE CUTTING EDGE BY ARLENE JOYNER, DDS

UNLV prepares its residents for a rapidly changing world. The University of Nevada, Las Vegas, (UNLV) School of Dental Medicine Advanced Education in Pediatric Dentistry is an innovative residency program that prides itself on keeping up with the cutting edge of products and services offered in the world of pediatric dentistry. The field of pediatric dentistry is constantly changing, ranging from preventative measures through full comprehensive treatment. We are no longer considered the “baby-tooth doctor.” Our treatment plan starts with developing a rapport first with the patient, then with the parent. Many parents who conduct their own research prefer treatment to be delivered without drugs. Dentistry has now become more relationship based than ever. Our children can now have happy smiles restored even if their teeth have been severely damaged. This is true regardless of how the damage occurred—whether through extended bottle usage (milk-bottle caries), through extended finger habits, or as a result of trauma. Pediatric dentistry interfaces with endodontics (facilitating apical closure using MTA), early orthodontic treatment (developing the maxillary and mandibular arches to accommodate their permanent successors), and restorative dentistry that emphasizes esthetics. We now have the products, techniques, and skills to restore dental

structures to a near-natural-like state. The diverse staff associated with our residency program ranges from pediatric dentists with 30-plus years of experience to the new pediatric dentist graduate. Our program embraces change and prides itself with ensuring that our residents learn to embrace cutting-edge technology. This commitment on our part allows a resident to maintain a balance, sampling a relationship with the old guard while keeping up with the newest advances in sedation. The importance of how parents perceive a child’s appearance has skyrocketed recently, forcing the pediatric dental community to provide a service that is in line with parental expectations. Today’s parents place an increasing priority on how their children are perceived by their peers. Pediatric dentistry also has been impacted by other changes in society and the economy, such as parents buying $300 shoes for their 3-year-olds. Given this shift in outlook, unsightly stainless steel anterior crowns, bulky white-faced stainless steel crowns, and silver fillings are no longer an acceptable choice for many parents. They want esthetics, no matter what the cost. In this new environment, EZPEDO introduced an esthetic Zirconia crown that met a pent-up demand for

Continuing Education Drs. Hansen, Fisher, and Joyner celebrate at the completion of an EZPU course held in Santa Monica, California.

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EZPEDO Magazine / September 2015


UNLV SCHOOL OF DENTAL MEDICINE Home of a cutting-edge pediatric dental residency program.

a more esthetic restoration. Fortunately, we can now offer parents the option of using crowns that are naturally life-like in appearance. Children are no longer stigmatized by unsightly crowns, and parents now have the option to give their child the smile they feel they deserve. EZPEDO crowns have been the crown of choice for me from their beginning. Dr. Hansen graciously

THE IMPORTANCE OF HOW PARENTS PERCEIVE A CHILD’S APPEARANCE HAS SKYROCKETED. came to UNLV School of Dental Medicine Advanced Education Program in Pediatric Dentistry and gave our residents a lecture and hands-on presentation in 2013. In 2015, I, along with another faculty member and two residents, attended EZPEDO University in Los Angeles, a first-class event demonstrating how to prepare and market EZPEDO crowns. I would highly recommend that all future pedodontic residents take this course to hone their skills in order to offer this service upon completing their residency training. Our residency program uses a variety of esthetic crowns, but in my opinion EZPEDO’s attention to quality control is more consistent than the other manufacturers of Zirconia crowns. Now more than ever, our residents’ choice of restoration for restoring decayed teeth is the EZPEDO crown. The natural, life-like look of these crowns provides a more viable alternative for restoring both anterior and posterior teeth. EZPEDO’s revolutionary innovation affords our residents a huge advantage of being able to train using this groundbreaking restoration that will be highly sought after once they leave the UNLV residency program. 


Dr. Jarod Johnson UNLV RESIDENT CLASS OF 2015

As a pediatric dentist beginning my career in private practice, I feel confident in the skills and techniques that I learned during my residency training at the University of Nevada, Las Vegas. During my study at the School of Dental Medicine Advanced Education Program in Pediatric Dentistry, I gained valuable experience using a variety of different restorative techniques. Restoring primary anterior teeth has always been a challenge. Composites, glass ionomers, amalgam, and stainless steel crowns are common and familiar materials used in residency programs. However, I soon discovered that strip crowns are technique sensitive and often stain or fracture after placement, stainless steel crowns are not esthetic, and pre-veneered stainless steel crowns look boxy, chip frequently, and often leave parents unhappy. My experience at UNLV exceeded my expectations by introducing me to a wide spectrum of restorative choices. In my training I was able to place many cases of pre-veneered stainless steel crowns and a few cases of Zirconia crowns made by different manufacturers.

Current UNLV residents are excited to be using EZPEDO’s Anterior, V2TM, and Prime SLTM Collections.

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EZPEDO Magazine / September 2015

WITHIN MY FIRST WEEK OF PRACTICE, I ALREADY HAD REQUESTS FOR “ALL WHITE” CROWNS. Dr. Arlene Joyner, associate professor-in-residence at UNLV, and one of our attendings, arranged to take me and a group of other residents to attend an EZPEDO University where Drs. Fisher and Hansen gave us the opportunity to learn the techniques required to successfully place EZPEDO Zirconia crowns. The clinical experience received at the EZPEDO course and the skills learned in my residency training have given me the confidence I need to offer Zirconia crowns in my own private practice. The customer service EZPEDO subsequently provided me as a new graduate has also been outstanding. As I begin my career in private practice, I am pleased to recommend EZPEDO Zirconia crowns to my patients and their parents. Within my first week of practice, I already had requests for “all white” crowns. Because of my experience at UNLV and at EZPU, I have had no hesitation providing this esthetic option to my patients and their families.


Our crowns. Her smile. Dr. Kim Feuquay UNLV RESIDENT CLASS OF 2012

EZPEDO Zirconia crowns have been a practice-changer for me. Having the option of offering parents esthetic crowns for their kids’ teeth is priceless, especially when a parent tells me, “My child is so self-conscious about her silver crowns that she won’t smile in pictures, and her friends make fun of her different-colored teeth.” Other parents who have seen EZPEDO crowns in the mouths of their friends’ children are even asking, “Can you replace my child’s silver crowns with the white ones?” These parents’ faces demonstrate such relief when they learn their children are not doomed to live with silver teeth but instead can choose an esthetic option using crowns that blend in with the natural surrounding dentition. I place just as many posterior EZPEDO crowns as I do anteriors, if not more. In the beginning, I experienced a learning curve while getting used to seating the posterior crowns, but now I can place a posterior EZPEDO crown just as fast as a stainless steel crown. I even find myself wishing the SSC companies would make their crown labeling as easy to use as the EZPEDO crown system, making it easy for auxiliaries to quickly identify crowns by tooth letter. I attended an EZPEDO University to gain confidence in prepping and cementing EZPEDO crowns and would highly recommend attending this one-day, hands-on seminar to everyone considering offering these crowns in daily practice. Parents and kids alike love the EZPEDO option!

...NOW I CAN PLACE A POSTERIOR EZPEDO CROWN JUST AS FAST AS A STAINLESS STEEL CROWN.

EZPEDO is proud to show you the actual smiles of the children we have worked with. So remember, if you see them in our ads, it’s because they’re our patients.


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BREAKING BARRIERS BY NEIDRE BANAKUS, DDS

THE WORLD’S FIRST 20-UNIT PEDIATRIC ZIRCONIA CROWN CASE.

EZPEDO Magazine / September 2015

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TENDER MOMENT Dr. Banakus gains the confidence of her little patient.

I vividly remember the first time I met Maryclaire. It was just five days after her first birthday. She was a beautiful little girl with perfect pudgy cheeks, adorable yellow locks, and a mouth full of bluish-gray teeth. She came to my office excited for her first dental visit, and left with a diagnosis of Dentinogenesis Imperfecta (DI). As I examined her mouth, I discovered that her primary teeth all had the bluish-gray discoloration that is classically found with DI. As I began explaining my findings with Maryclaire’s mother, she was shocked and extremely concerned with the diagnosis. I immediately referred her to her pediatrician for further evaluation,

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and her pediatrician ordered a genetic panel. The genetic panel determined that she has a spontaneous mutation that includes Osteogenesis Imperfecta (OI). However, Maryclaire has never exhibited any manifestations of OI. Her definitive diagnosis was made after genetic testing as: Dentinogenesis Type 1; Osteogenesis Imperfecta with DI, Shield Type 1. Dentinogenesis Imperfecta causes the teeth to be discolored (most often a blue-gray or yellow-brown color) and to exhibit translucency. Maryclaire’s teeth exhibited both color variations and translucency. DI causes weakening of the teeth, which often includes rapid wear


and abnormal pulp anatomy. DI can affect I CREATED A TREATMENT PLAN BASED ON HER CLINICAL both primary and permanent dentitions. AND RADIOGRAPHIC FINDINGS. THIS PLAN INCLUDTreatment modalities most often involve full-coverage restorations and MaryED FULL-COVERAGE CROWNS ON ALL 20 DECIDUOUS claire’s case exhibited the need for full TEETH. I HAD NO RESERVATIONS ABOUT MY ABILITY coverage in all primary teeth. Over the next 16 months, Maryclaire TO PREPARE HER CANINES AND LATERAL INCISORS FOR was medically cleared for traditional genZIRCONIA CROWNS. eral anesthesia in an outpatient dental surgery center and had a multitude of other medical evaluations, including cardiac and hearing screenings, which were all normal. At my office, I kept a close eye on Maryclaire and during our in-office visits, every two to three months, we charted wear on the maxillary and mandibular incisors with continuing flaking of enamel and dentin exposure. Her parents were diligent about excellent home care and optimizing fluoride supplementation. I advised against any type of electric toothbrush to protect remaining enamel, since it was so weak and unpredictable. She used an extra-soft bristle toothbrush at home that seemed to remove plaque effectively and not expedite any wear on her teeth. Maryclaire never exhibited any sensitivity in her teeth and was able to eat and speak effectively. She did have a pacifier habit until her surgery date and displayed a classic class-2 occlusion with an open bite that was habit related. MARYCLAIRE Between our first visit and her treatment date, all of her primary teeth erupted fully and all exhibited Taking a peek at her new smile. DI. We were able to obtain radiographs prior to her general anesthesia date and were able to assess pulpal status and size. Her incisors and canines exhibited a smaller, receding pulp chamber. Her molars exhibited larger pulp chambers with a thin enamel/dentin layer. At this point, my main concern was the size of the molar pulps and exactly how much tooth structure would be preserved during crown preparation. I created a treatment plan based on her clinical and radiographic findings. This plan included full-coverage crowns on all 20 deciduous teeth. I had no reservations about my ability to prepare her canines and lateral incisors for Zirconia crowns. However, I tentatively planned on placing stainless steel crowns on her molars to reduce the risk of pulpal exposure. I reviewed with her parents that the most important aspect of placing crowns for her would be to avoid pulpal exposure, since her pulp chambers were abnormally shaped and might not respond predictably to pulpal treatment. I did let them know that once I started preparation there was a small chance that I could place Zirconia crowns on her molars as well. Due to deterioration and loss of enamel on her anterior teeth, I elected to do treatment under general anesthesia when she was two years and four months of age. She responded well under general anesthesia, and we completed all her restorations in one visit. She even stopped her pacifier habit and potty trained herself in the week following treatment! During treatment, I prepared her incisors and canines first and cemented her crowns in groups of two to three to simplify alignment, ensure hemostasis, and to be able to apply finger pressure to each tooth as the cement hardened. I used Ketac cement for all crowns.

EZPEDO Magazine / September 2015

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Her anterior preparations were classic and straightforward with no signs of nearing her pulp chambers. As I approached her posterior molars, I prepared the occlusal surfaces first and was anxious about what amount of pulpal tissue I might encounter as I prepared the teeth. However, I was able to perform enough occlusal reduction for Zirconia crowns with no sign of a blushing pulp. The rest of the molar preparation was conservative, and I had no problem preparing the mesial-distal-buccal-lingual surfaces without nearing the pulp. I was extremely excited to be able to place Zirconia crowns on all of Maryclaire’s teeth! During her treatment, clinically I was very pleased with the amount of tooth structure I was able to preserve. I wasn’t sure what quality of tooth structure I would encounter and with good reason. She had islands of remaining enamel over moderately soft to very flaky bluegray and yellow-brown dentin underneath. I prepared the teeth while removing as little tooth structure as possible and in some areas I was able to preserve a moderate amount of enamel. Immediately following anesthesia, I spoke to Maryclaire’s parents and showed them post-operative pictures. Their response was more than I could have hoped for and was a mixture of relief and happiness that Maryclaire was finished with this first chapter dealing with DI. When Maryclaire’s parents saw her new smile, their expression was priceless and one I will never forget. I explained that Maryclaire did have a pre-existing open bite from her pacifier habit which I had to replicate, but that I felt this would close nicely if she stopped her pacifier habit soon. Maryclaire hasn’t used her pacifier since. At her follow-up appointments, we found her open bite is closing nicely, as if the crowns are completely her natural tooth structure. As a pediatric dentist that takes pride in ensuring that each patient will experience the best possible outcome, Maryclaire’s case exceeded

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IN THE OFFICE Dr. Banakus doing a follow-up exam on Maryclaire.

THE TRANSFORMATION OF A BEAUTIFUL LITTLE GIRL WITH CRUMBLING TEETH THAT WERE LITERALLY ON BORROWED TIME INTO A CONFIDENT LITTLE GIRL WITH NO RESERVATIONS ABOUT HER SMILE IS UNBELIEVABLY REWARDING.

Complete maxillary and mandibular arches restored with EZPEDO Zirconia crowns.

EZPEDO Magazine / September 2015


my expectations. The transformation of a beautiful little girl with crumbling teeth that were literally on borrowed time into a confident little girl with no reservations about her smile is unbelievably rewarding. Thanks to modern dentistry, I was able to prevent pain in her teeth and mouth, as well as protect her from the social and societal ramifications of having DI in her young, formative years. Clinically, preparation for a Zirconia crown becomes second-nature with practice and following the steps laid out by the EZPEDO team. The learning curve with Zirconia crowns isn’t steep, and once you reach a comfort level, the ability to provide high-quality, esthetic, strong restorations is invaluable to one’s practice. This case showed me the possibilities of providing a full-mouth restoration with Zirconia crowns, but more importantly, I was able to dramatically enhance a little girl’s life. 

MARYCLAIRE’S FOLLOWUP Showcasing a fullmouth restoration with EZPEDO crowns.

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MOMMY’S LITTLE GIRL BY MELLISA – MARYCLAIRE’S MOM

THERE’S NOTHING BETTER THAN KNOWING YOUR CHILD RECEIVED THE BEST THERE IS. MARYCLAIRE’S STORY CONTINUES ... FROM HER MOM’S POINT OF VIEW. “So, when did all of your baby’s teeth turn white?” I recall asking other moms in my daughter’s playgroup. I consider myself a pretty smart person; heck, I’m even a nurse who knows a thing or two about the human body. But can anything really prepare you for the role of first-time mom? In retrospect, it seems like such a dumb question, like I should have known there was a problem from the very beginning when Maryclaire’s translucent-gray teeth peeked above the surface of her gums. I wasn’t all that concerned because Maryclaire’s recent checkup gave her a clean bill of health. I shrugged it off and worried about other things. But as her teeth continued to erupt, I became more concerned. At our next doctor’s appointment, our pediatrician noticed her teeth before I could even point them out and referred me to two local pediatric dentists. I still wasn’t that worried, because I thought it wasn’t anything that a routine cleaning couldn’t fix. Since I knew that one of the recommended dentists was retiring, I picked the second one. “Score!” I thought, “The office is right down the street!” I didn’t know at that point just how important that decision would be for us in the months and years to come. Lucky pick, because I’m convinced Dr. Banakus is not only the best pediatric dentist in town, but in the whole wide world. It was an exciting morning—Maryclaire’s first dental appointment. I snapped a picture or two on my iPhone. We were taken to a private exam room, and I was more concerned about keeping my 1-year-old daughter off the equipment than I was about the visit. Dr. Banakus took a look at Maryclaire’s teeth and made a swift diagnosis. She quickly warned me not to go home and Google the condition until she had an opportunity to personally e-mail me actual scientific literature and reputable sources of information. She said she would be in contact with our pediatrician and that she was concerned about how the dental condition is closely linked to manifestations in the skeletal system. She said a lot of other stuff, too. I don’t remember much except that I was finding it hard to breathe. Naturally, I went home and Googled what the hygienist had scribbled on a sheet of paper, “Dentinogenesis Imperfecta (DI).” People with bright blue sclera and open mouths with snaggle teeth stared back at me. I learned that some manifestations were even fatal. My list of questions and worries grew and grew. Maryclaire had always been, and still is, a very happy child. She had never complained about any discomfort with her teeth and seemed fine. She smiled and laughed all the time.

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EZPEDO Magazine / September 2015

It hit me that this was all going to change. I couldn’t stop thinking about how much pain she would likely endure and worried about what other problems she might develop that we didn’t even know about yet. Would she be able to play like a normal kid? Would she continue to develop and grow like she should? Would other kids make fun of her smile? Her teeth would certainly become a source of embarrassment and fodder for bullies. It pained me to even think she would ever not want to smile. I appreciated how Dr. Banakus saw beyond her own specialty. She educated us and advocated for us to investigate other manifestations of Maryclaire’s genetic condition. It turns out she has a denovo mutation for a collagen gene on chromosome 7. With the help of our pediatrician, we saw genetic counselors, an Osteogenesis Imperfecta (OI) specialist, a cardiologist, and an audiologist. With Dr. Banakus, we developed a plan to care for Maryclaire’s teeth. She recommended crowning all of her teeth. Our goal was to wait at least until she was 2½ for her surgery. So we planned to perform meticulous oral care, monitor the deterioration of her teeth every three months, perform fluoride varnishes and fluoride supplementation, and avoid acidic and cavity-promoting foods. We became tooth-brushing pros. I went on a mission to eradicate goldfish crackers from the planet. You know what? Kids survive without crackers and chips and sticky, gooey fruit leather. I took Maryclaire to tour a preschool that we were very interested in. At snack time, moms were handing out snacks of graham crackers and orange wedges. I just about had a seizure. I snatched up her graham cracker and put a halt to the incoming citrus, dripping with acidic doom. Okay, I wasn’t really that dramatic, but what came after was the barrage of questions and stares and me stuttering to explain my child, who was now viewed as some sort of specimen in the room. It was the first time I had to deal with explaining my daughter’s teeth to strangers. Everyone was nice about it, but I just wanted to scoop up my girl and leave. The day before the surgery, I realized I was going to miss Maryclaire’s natural teeth. They weren’t ugly to me. They were all I had ever known, and Maryclaire was still too innocent to know the difference. I snapped a couple of pictures, just because that was her smile, and I loved it.


MOM ON A MISSION To protect Maryclaire’s teeth, her mom went on a mission to eradicate gold fish crackers from the planet.

We talked to Maryclaire about the planned procedure and told her she was going to be getting “princess teeth”from Dr. Banakus. We had discussed the aesthetic options for the crowns, and planned to do the white crowns canine-to-canine with stainless steel crowns in the back. While Dr. Banakus thought that the white crowns would be durable enough for the molars, she was unsure if she could fit them with the irregular root structure of Maryclaire’s DI teeth.

The procedure lasted about three hours. When Dr. Banakus came out to the waiting room, she was so pleased to share the good news—she had seated the white crowns on all of Maryclaire’s teeth. She exclaimed, “Maryclaire’s teeth look beautiful.” I agreed. They certainly do! I’m relieved to have had such an esthetically pleasing and fully functional solution to our daughter’s dental condition. Maryclaire’s teeth now look so real no one would ever guess her teeth are crowned. What could have been a real nightmare for a kid (and a parent) turned out to be a gratifying experience for us all.  EZPEDO Magazine / September 2015

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EZPEDO’S COVER GIRL Autumn has teeth D E F G and B restored with EZPEDO Zirconia crowns.

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Meet Autumn BY JEFFREY FISHER, DDS & VICTORIA SULLIVAN, DDS

She’s so much more than just a pretty smile. Many of you have come to recognize Autumn’s smile. Surrounded by beautiful blue and purple flowers, she has become the “cover girl” for most of our advertising this year. Autumn’s contagious smile and bubbly little personality are a true testament to the miracle of childhood. But what many don’t know is that her story could have ended much differently, because Autumn almost lost her smile at the tender age of 18 months. As dentists we see new parents and patients every single day. Sometimes we have good news for them, “Great job. No cavities today.” But other times that is not the case. Informing a new mom that her little child needs her front teeth crowned, or, even worse, might need to have them extracted is routine for us. However, what happens during a typical day at work for us can deliver a devastating blow to an unsuspecting parent. A mom’s life may have just been upended, and the uncertainty of what the future holds can be scary and overwhelming.

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Autumn’s mom faced such a situation when she received news that caused her a great deal of anxiety. A dentist had just told her, “Your child needs general anesthesia to extract all four of her front teeth.” Perplexed, and having recently moved to a new area, Autumn’s mom used Google to help her decide which office to visit for a second opinion. Unfortunately, decay is decay. The diagnosis and suggested treatment was the same everywhere she went. The thought of having to put Autumn under general anesthesia and still face an uncertain outcome was devastating. Desperate to find hope, she tried one last dental office near her home. That’s when everything changed.

Dr. Victoria Sullivan’s Experience Treating Autumn

BEAUTIFUL MOMENT Autumn’s beautiful smile lights up her mother’s world.

Xol was shocked. No one had even broached the option of using esthetic crowns, let alone saving Autumn’s teeth. We looked at all the crown options, and I explained in depth my reasoning and my confidence in the EZPEDO crowns I was proposing.

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EZPEDO Magazine / September 2015

When Xol and her daughter, Autumn, walked into my office, Xol was very frustrated and disheartened. She had been to two or three other dental offices seeking treatment for Autumn’s teeth. At those offices, dentists told her that the only option for Autumn was to extract her teeth under sedation. Autumn was a beautiful, vibrant 3-year-old, and Xol was feeling very guilty and worried about the possible loss of Autumn’s teeth. Additionally, she was very opposed to sedation. I reviewed Autumn’s X-rays and did a clinical exam. I found that Autumn had enough root structure for restorations, so I proposed EZPEDO crowns with pulpectomies. I felt the structure of #D would be questionable, but perhaps a buildup might facilitate placing a crown. Xol was shocked. No one had even broached the option of using esthetic crowns, let alone saving Autumn’s teeth. We looked at all the crown options, and I explained in depth my reasoning and my confidence in the EZPEDO crowns I was proposing. Just a week or two later, I placed EZPEDO crowns on all four of Autumn’s anterior teeth while she was awake. The results were beautiful and Xol was really happy. She made cookies (or was it cupcakes?) and brought them to share with the whole office staff. We all celebrated Autumn’s brand new smile. About a month later, unfortunately, #D fractured off at the gum line. Xol was sure we would now have to extract the tooth. However, I was able to construct a buildup in composite and place a new crown onto #D. That was over a year ago. Since then I have treated Autumn on other occasions for posterior teeth, and the results have been equally good. Autumn is still a remarkably vibrant and engaging child. I think her gorgeous smile is one of her best assets. I was so proud to be able to care for Autumn and have a part in changing her life. She now has natural-looking front teeth, and she smiles all the time. It was my privilege to restore that beautiful smile. I like to think that in the eyes of this little child, I got to be a superhero. As pediatric dentists, that is what we live for—the opportunity to help children smile. EZPEDO has allowed me to give my patients beautiful, natural, healthy smiles with happy gums and long-term success. The materials are beautiful. The bur block and EZPEDO University training make application a snap, and both children and parents are thrilled with the outcome. Anyone can use EZPEDO products, and everyone should, because the results are win-win for both patients and practitioners.


CREATIVITY Confidence breeds creativity and it’s no different for Autumn.

“I like to think that in the eyes of this little child, I got to be a superhero. As pediatric dentists, that is what we live for – the opportunity to help children smile.” – Victoria Sullivan, DDS

CROWNS ARE PERSONAL No one needs to know about her crowns, whether EZPEDO Magazine / September 2015 they’re in the front or in the back.

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Like Xol, parents from all over the country face similar dilemmas every day. Here at EZPEDO we frequently receive phone calls from moms and dads looking for resources to help them find a dentist in their local area who is willing to provide Zirconia crowns for their children. As our industry continues to change, there will always be dentists who prefer to continue providing treatment the same way they always have. But those of you who have stepped out and embraced modern advancements in your field are not only amazing dentists but will forever be the recipients of inexpressible gratitude from parents and children whose lives you have changed forever. ď ľ

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EZPEDO Magazine / September 2015


“But those of you who have stepped out and embraced modern advancements in your field are not only amazing dentists but will forever be the recipients of inexpressible gratitude from parents and children whose lives you have changed forever.” – Jeffrey Fisher, DDS

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REAL ISSUES / RESEARCH

weighing the evidence BY JOHN HANSEN, DDS

A guide to evaluating pediatric Zirconia crowns. Evaluating the performance of pediatric Zirconia crowns solely based on strength is a moot point. To understand this concept more clearly, there are two theoretical questions we need to answer:

1. HOW STRONG DO PEDIATRIC CROWNS NEED TO BE? Let’s look at the science. Many studies have been done on bite force in kids. The most recent study1 I know of is found in the International Journal of Pharmaceutical Science and Health Care published in 2012. This study cites the average maximum bite force of children ages 8–12 as 191 Newtons(N) (183N for girls and 199N for boys) compared to the average adult bite force of 602N. Thus, for a pediatric crown to be strong enough, its fracture resistance must exceed the pediatric bite forces cited above with a built-in safety margin.

2. WHAT MAKES ONE BRAND OF ZIRCONIA CROWNS STRONGER THAN OTHER BRANDS?

One conclusion of the study was that the fracture resistance of EZPEDO crowns (1091N) was the greatest of the three brands. Before we all get too excited and celebrate that EZPEDO was the “winner” in this strength study, let’s look a little deeper, and hopefully you will better understand the significance of this study. A second conclusion Townsend made is that there is a positive correlation between the thickness of the crown and fracture resistance. Yet a third conclusion of the LSU study noted above is that the mean force required to fracture the crowns of all three brands exceeded the maximum bite force of a child, thus calling into question the CLINICAL SIGNIFICANCE of fracture resistance differences even though they were shown to be STATISTICALLY SIGNIFICANT. (What truly is clinically significant is the ideal blend of wall thickness combined with ease of fit; see discussion of EZPEDO’s design philosophy below.)

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CLINICAL SIGNIFICANCE

Janice Townsend led a detailed fracture resistance study2 at Louisiana State University (LSU) that evaluated the strength of three brands of pediatric Zirconia crowns.


This neutral conclusion drawn by Townsend at LSU was corroborated by yet another study of material fatigue conducted at Indiana University.3 This latter study also concludes that “All three crown types were found to withstand the maximum bite force of pediatric patients as determined in a previous study.” 4 Thus, stronger (very high fracture resistance) is not always better. Strength that far exceeds a child’s maximum bite force is not necessarily superior, particularly if one must prep more aggressively and compromise tooth structure in order to achieve that strength.

WHAT CAN WE LEARN FROM THE SCIENTIFIC STUDIES? Considering the results of the three studies cited above, here are two key points supported by science: Key Point #1. Crown Strength is a Function of Thickness. Sure there are other factors that can influence strength, such as sintering which can modulate crystal size, and non-homogenous density regions that are inherent to injection-molded parts. But nothing makes Zirconia crowns more robust and stronger than thicker material.

STATISTICAL SIGNIFICANCE

Key Point #2. All Brands of Zirconia Crowns Are Strong Enough to Far Exceed the Maximum Bite Force in Children. As long as the fracture resistance of a crown exceeds a child’s bite force by an additional safety margin, increasing the wall thickness is not necessary, especially if it creates a secondary problem of requiring greater tooth reduction when prepping a crown. WHAT IS THE NUMBER ONE CHALLENGE THAT DOCTORS FACE WHEN PLACING ZIRCONIA CROWNS, REGARDLESS OF THE BRAND? This is the urgent, practical question we must ask when investigating how to evaluate Zirconia crowns. While no research exists to cite (that I am aware of), visit the Dental Town Web site and read the posts. The greatest challenges dentists face always involve the same three things: 1) how to minimize the amount of tooth reduction, 2) how to facilitate the placement of crowns in back-to-back cases, 3) how to minimize chair time. At the annual EZPEDO Symposium—our study group and think tank for improving our product—80% of the doctors attending wanted to improve their speed when placing Zirconia crowns. HOW DOES EZPEDO’S DESIGN PHILOSOPHY ADDRESS THESE CHALLENGES FACED BY DOCTORS? Being the first company to develop a product is a double-edge sword. On one hand, it’s great to develop a new product that improves the lives of its users and drives an industry in a new direction. On the other hand, it’s just not possible for the first rendition to include every feature.

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Take my iPhone for an example. As attached as I was to my iPhone 3GS, I finally decided to upgrade after three years even though I was the only one in my family that hadn’t broken my phone. Now I have discovered my current iPhone 6 Plus is simply a masterpiece. THE IMPORTANCE OF TIME. It takes time—even years of R and D to receive enough valuable feedback and accumulated data to intelligently make design changes that result in vital improvements. EZPEDO has been on the market two years longer than any other brand. This advantage of having the longest track record of clinical use and practitioner evaluation has enabled us to continually improve our product based on customer feedback and scientific advances. Our original posterior crowns were used in the 2012 LSU strength study cited above. Our crowns (the thickest in the study) proved to be the strongest, but we also discovered that many doctors were having challenges using this early version of our crowns, particularly in back-to-back and space-loss situations.

WE CAME TO THE FOLLOWING CONCLUSION. Since Zirconia strength is primarily a function of its thickness, wouldn’t it seem reasonable to make the crown wall just thick enough to safely avoid fracture from bite forces, but also as thin as functionally possible with modified tooth-saving contours? We fortified the thickness of the crown where it matters—in the fracture-prone axial-occlusal line angle— while maintaining an ideal reduced thickness down the less vulnerable remainder of the axial wall to the crown margin. The result is an optimized wall thickness that facilitates an easier passive fit. Most importantly, this design modification, 1) minimizes the amount of tooth reduction, 2) reduces the chance of pulp exposure, 3) allows the restoration of multi-unit and back-to-back cases, and 4) saves valuable chair time. These considerations were the driving force behind our new V2TM crown design introduced in 2014. These crowns combine just the right amount of thickness with EZ-SeatTM and Margin-LockTM design features. Our V2TM product line exemplifies the current pinnacle of pediatric Zirconia technology. 

ENDNOTES: 1. “Assessment of Maximum Voluntary Bite Force in Children and Adults with Normal Occlusion,” by Haritha Sathyanarayana and Sridhar Premkumar in International Journal of Pharmaceutical Science and Health Care, Issue 2, Volume 1 (February 2012), pp. 54–70. 2. “In Vitro Fracture Resistance of Three Commercially Available Zirconia Crowns for Primary Molars,” by Janice A. Townsend, et al in Pediatric Dentistry, Vol. 36, No. 5 (Sep–Oct 2014), pp. E125–29. 3. “The Effects of Cyclic Fatigue on the Fracture Resistance of Three Esthetic Pediatric Crowns, ” by Jaime L. Orrick (Indiana University) in Pediatric Dental Restorations (May 2015). 4. An EZPEDO competitor has chosen to give this study a misleading spin. Kinder Krown’s advertising selectively emphasizes the results of this study which give their crowns a higher “load to failure” value which they taut as a sign of greater durability. This advertising fails to point out, however, the conclusion of the study (they conveniently avoid even mentioning it) which asserts that “All three crown types were found to withstand the maximum bite force of pediatric patients . . . .” ADDITIONAL REFERENCE FOR STUDY: “Aggressiveness of Preparation Necessary for the Passive Fit of Differing Anterior and Posterior Zirconia Restorations in the Primary Dentition,” by Larkin L. Clark (UTHSC) in Pediatric Dental Restorations (May 2015).

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EZPEDO Owner/Co-founder Dr. John Hansen, DDS


EZPU EZPU EZPEDO UNIVERSITY UNIVERSITY EZPEDO

EST. 2013 2016

The first hands-on pediatric Zirconia crown course. . EVER.

Total number of courses through 2016.

Course graduate’s average increase in crowns placed vs. those who have never attended.

EZPEDO UNIVERSITY

Number of doctors who have graduated from EZPEDO University.

It’s by far the largest, most experienced, and respected pediatric Zirconia course on the planet.

It’s more than just a course. It’s an experience. EZPEDO Magazine / September 2015ezpedo.com/ezpu 39


REAL ISSUES / RESIDENCY EXPERIENCE

A Look back EZPEDO MAGAZINE INTERVIEWS DUSTIN JANSSEN, DDS

How what I did in residency shapes what I do in private practice.

Dr. Janssen Recalling his first EZPEDO experience.

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It is encouraging to observe how EZPEDO is constantly striving to improve their product by reaching out for feedback from the doctors who are actually placing the crowns. EZPM. EZPEDO first introduced the world to prefabricated pediatric Zirconia crowns back in 2010. When did you first learn about pediatric Zirconia crowns, and how did they change your experience in pediatric dentistry? DJ. I began my pediatric dental residency in 2011 after working for two years as a general dentist. I entered residency with the hope and intention of gaining all the skill sets possible to provide exceptional care for the children I treat. As a first-year resident, I was put in charge of fixing fractured strip crowns. This became a daunting task, one I didn’t wish to make a part of my own everyday practice. For this reason, I began researching alternatives for anterior restorations. I was dissatisfied with the lack of esthetics provided by resin-faced stainless steel crowns. Soon, however, I realized there was a new Zirconia crown option that possibly might provide both the durability and esthetics I had hoped for. I presented this idea to my program director and got the green light to use these crowns if I could get samples for the clinic. Since then I have never looked back. During my two-year residency, I had the amazing opportunity to try all available anterior restorations for children. I am so thankful that I now have an alternative to stainless steel crowns that provides a strong, esthetic, and predictable restoration for my patients. EZPM. How did the experience of using many different manufacturers’ pediatric Zirconia crowns in residency influence your decision to choose EZPEDO crowns for use in your private practice?

DJ. I was able to order three different brands of Zirconia crowns to evaluate during residency. As a practicing dentist it would not be cost effective to purchase all the brands of Zirconia crowns. Because of this cost restraint, many practitioners seem to make a knee-jerk decision and then just stick with a certain crown because of their financial investment in that particular brand. As a resident, I was able to independently evaluate the crowns without the constraints that would be required if I were in private practice. After many restorations and follow-up visits, it became clear to me that EZPEDO crowns were superior in their esthetic appearance and also required less tooth structure removal in order to seat them properly. Their EZ-Seat™ design allows these crowns to fit more precisely in crowded dentitions without having to complete pulpal therapy. EZPM. As you look back over the last four years, how have the Zirconia crowns you use been improved—new shapes, design changes? And what have these improvements meant for you as a practitioner—ease of use, speed of placement? DJ. Since I was an early adopter of Zirconia crowns, no training programs like EZPEDO University were yet available to provide hands-on skill training. For this reason, I had to learn the techniques on my own by trial and error. In many ways this was good for me because it really forced me to think about how to improve my efficiency and technique. To my knowledge, EZPEDO has made the most dramatic improvements to their crown design since their product launch. The relaxed contours and slight profile modifications (especially for the posterior crowns)

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have significantly enhanced the ease of placement. It is encouraging to observe how EZPEDO is soliciting feedback from the doctors who are actually placing the crowns and constantly striving to improve their product! EZPM. For the average pediatric dentist interested in incorporating Zirconia crowns into a private practice, how important is continuing education for easing the transition into adopting this new technology? DJ. As I said earlier, I personally learned how to efficiently place these crowns by trial and error. This is not the method I would recommend for my colleagues, however. EZPEDO realized that one sure way to ensure practitioners feel comfortable placing these crowns on their patients was to provide hands-on sessions and individual guidance. Now, with courses offered by EZPEDO University, you have an opportunity to work with your peers and receive over-the-shoulder, hands-on training in mastering the preparation of a Zirconia crown. EZPM. From your own personal experience opening a new pediatric dental practice from scratch right out of residency, how has the ability to offer Zirconia restorations helped in that process? DJ. Opening a practice from scratch has been quite an adventure. My best advice is to seek council from smart people around you who have done it before. I had an amazing group of mentors who guided me through this tedious process. One of their best recommendations to me was to always put the patient first and treat every child as you would treat your own children. As a father of two girls, it is an honor to have other parents trust me to care for their children. Many parents who come to my practice are devastated because they have been told that the only option for fixing a severely decayed tooth is to put a silver cap on it. These parents are instantly relieved that I offer more esthetic treatment options in my office. Offering a white, natural-looking crown alternate has become a great referral source for my practice. I do not rely on any advertising to build my patient base. Because of this fact, it is imperative that my patients receive exceptional care that exceeds normal expectations. Patients with beautiful smiles and their satisfied parents are the best source of referrals I could ask for.

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EZPM. Do you have any words of wisdom for dentists who are interested in incorporating pediatric Zirconia crowns into their practices, whether they be residents in training or private practitioners who have been in business 30-plus years? DJ. A great quote from Will Rogers says “Even if you are on the right track, you will get run over if you just sit there.” This holds true in many areas of our lives. With the introduction of pediatric Zirconia crowns, we now have the opportunity to provide superior esthetics without compromising the strength of our restorations. To a resident, I would recommend that you try to learn all you can while in the confines of your residency, because once in private practice it is easy to become stagnant with your techniques. To the dentist who has been in practice for 30-plus years, I would challenge you to not downplay the new possibilities that are now available. Zirconia crowns introduce a great treatment alternative—one that has already changed the face of pediatric dentistry. 

It is an honor to have other parents trust me to care for their children.


EZPEDO Magazine / September 2015

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Where We’ve Been & Where We’re Going

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I

“I love working with John Hansen, and one day we’re going to do something big,” Jeff Fisher recalls as he describes his initial partnership with John Hansen before EZPEDO was even conceived. Five years after launching EZPEDO, they have indeed done something big. Dentists by profession, Fisher and Hansen set out to revolutionize pediatric dentistry in 2010 by launching the company and introducing the profession to the first pediatric Zirconia crowns. Since then, their impact has been felt throughout the United States, and they’ve even made their footprints in the international marketplace.

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When a new product hits the market, dentists throughout the world need to learn how to benefit from the new technology.

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h

the enormity of the task can be overwhelming, and half the time you don’t even know where to start,” Fisher says. Nevertheless, the two dove in headfirst, and their V1 product began to flourish. However, the work didn’t stop there. As Hansen says, “We’re always looking for opportunities to do things better. I’ve spent a lot of my time doing cases and teaching techniques to other doctors. We also receive feedback from dentists using our crowns. As a result of our personal experience with the crowns and the feedback we receive from dentists, we continually make changes striving to improve our crowns. It’s almost like it’s in the dentist’s DNA to create these products and just keep making them better.”

How It All Began

The inspiration for the idea was sparked by Hansen’s experience with his son, John Paul, and Fisher’s extensive experience with pediatric dentistry and knowledge of the drawbacks of existing crown technology. Hansen’s 3-year-old son had fallen in the bathtub and badly chipped his front teeth. Hansen discovered that the crown options available to him as a parent were less than satisfactory. John Paul continually cracked his crowns. Frustrated, Hansen took matters into his own hands. “Having my own in-house laboratory,” Hansen explains, “I had the ability to actually make John Paul some restorations based on adult technology so that they would last.” After that, the idea turned into a formula, which turned into a business. “Jeff and I had a conversation one day about pediatrics, durability, and esthetics. We basically came up with the idea to make a pediatric crown that would last,” Hansen recalls. Although they weren’t the first to experiment with a lasting pediatric crown, none of the earlier efforts worked long-term. “They have all failed, broken, and they don’t last,” Hansen says. “Ours was the first white pediatric crown that worked.”

First Prototype

Hansen and Fisher created their first Zirconia prototype and began to offer pediatric dentists an alternative to the clunky, white-faced steel crown and the less-durable composite crowns previously used to repair Hansen’s son’s teeth. The new Zirconia crown used technology similar to what Hansen typically uses in adult dentistry. The crown boasted something that none of the alternatives had—both durability and esthetics. Fisher began taking the prototype crowns to local dentists for whom he provided anesthesia and immediately started receiving positive feedback. “Whenever you’re changing an industry and bringing something brand new to the profession,

Practicing Dentists

The unique advantage that Fisher and Hansen have is that they have continued their practices alongside EZPEDO and, in turn, use their own product in their practices. While many companies manufacture a product and ship it out, EZPEDO is on the frontline of not only manufacturing their product but also in testing its effectiveness. “We actually use our own product, and, for us, it’s never good enough. We’re always wanting to make it better and better,” Hansen says. EZPEDO’s motivation to continually improve the Zirconia crown has led to continual steps forward in innovation. Fisher explains that understanding the technique of seating crowns is often the key to improvement. “How do I make the process more affordable and faster? That’s what everyone wants. And the goal is not cheaper and faster from the standpoint of making more money. It’s less expensive and faster because I have a 3-yearold that doesn’t want to sit here,” Fisher explains. Understanding that successful pediatric dentistry hinges heavily on the state of a restless child having his teeth worked on, Fisher is continually challenged to increase the efficiency of the product. The question was always, “How can we do this procedure easier and faster, so that kids don’t have to be in the chair any longer than absolutely necessary.” By understanding the implications of cost and speed through their own practices, EZPEDO’s founders have a leg up on their competition in delivering a next-gen product that will not only provide lasting esthetics and durability but will also be cost-effective for families.

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EZPEDO University

EZPEDO could easily have produced and sold their crowns and never gone the extra mile in caring for their patients or practicing dentists. However, Hansen and Fisher don’t operate that way. “Being dentists, we felt the obligation to say, ‘Hey, there is a whole generation of people who aren’t being taught this in their school or residency programs,’” says Fisher, who had only been out of his residency for a couple years when he and Hansen had their initial conversation. “How do we bridge the gap between our product’s potential and the experience of practicing dentists? That’s where the whole concept of EZPEDO University came from.” When a new product hits the market, dentists throughout the world need to learn how to benefit from the new technology. Because EZPEDO was such a trailblazer in the dental market, there was no existing training available on how to integrate their crowns into private practices. EZPEDO University was formed to offer a hands-on workshop for dentists, providing them the knowledge and skills required to begin using pediatric Zirconia crowns successfully in their own practices. EZPEDO University sparked a new level of growth for the company. “John has been so awesome at putting classes together and bringing in experts that aren’t just from EZPEDO,” Fisher observes. “Practicing dentists and peers participate who are able to say, ‘Hey, this is how it changed my life and my practice, and I just want to share that with you.’” Having voices from outside the company lecture in this educational venture has helped to give credence to the emerging technology.

We’re always looking for opportunities to do things better. EZPEDO Magazine / September 2015

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California. Though they were successfully growing, the initial financial commitment was a bold risk. Hansen explains, “There’s only so much capacity you can have in a dental office. At some point we had to grow. The investment for the machinery and the equipment was a leap of faith. We knew the product worked, and the doctors that Jeff works with on a daily basis knew the product worked, but that was just our own community. We had to hope other dentists in other communities would have the same feeling. The capital investment was the biggest risk.”

Supportive Families

TAKING TIME TO PLAY Fisher and Hansen enjoy a game of bocce ball at the location of next year’s EZPEDO Annual Symposium at Lake Tahoe, Calif.

Dentists and Dads

Despite their company’s growth, Hansen and Fisher still maintain their humble beginnings. EZPEDO has found success through a personal touch and through deep knowledge of the negative experiences that can occur in pediatric dentistry. Hansen and Fisher make it their mission to not focus solely on profit and quantity, but rather on the number of lives changed. Hansen’s own experience with John Paul certainly played a role in crafting their mission statement and in fostering their belief that changing a patient’s life is the most rewarding part of their success. “Being a parent, you want the best for your kids. When your kids have dental issues, you want them to get healthy again and feel good about themselves,” Hansen says. Fisher and Hansen’s own experiences helped shape their understanding so that they could maintain a level of empathy with their clients. “Being a dentist is one thing, but being a dad and wanting the best for my own son, is another thing. It’s a great feeling to know that we’re affecting so many other kids in the same way. We get thanks from doctors all the time, but we also get phone calls from parents who will actually contact our company and tell us stories about how our crowns have positively impacted their kids’ self-esteem and confidence. It’s pretty cool.”

Taking the Risk

EZPEDO began in the small lab in the back of Hansen’s dental practice in Roseville, California. After outgrowing two other office spaces, they resettled into a larger space in Loomis,

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The financial risk wasn’t the only sacrifice Hansen and Fisher had to make. With full-time practices already consuming their time, committing to EZPEDO meant less time with their families. “That’s where the passion comes in. You’re willing to do those things, because you know that it’s something that’s going to make a difference,” Fisher affirms. “You’re willing to push that extra mile because you know it’s worth pushing for.” Both Hansen and Fisher are quick to give credit to their families for supporting their vision. “I haven’t had the luxury of being able to stop my dental practice and fully focus on EZPEDO,” Hansen says. “I still do both. It has been a big sacrifice for my family. My wife Brenda works almost seven days a week now for EZPEDO because it’s become a bigger company than my dental practice ever was. It’s a lot of work and a big time commitment for us and involves a lot of time away from our family as well.” “We were both young dads, and we both had wives who noticed that we were working hard,” Fisher explains. “There were days they knew it was going to succeed, and there were other days when they had questions. You go through times where you want to be happy and spend more time at home, but you have to go work and hope they understand. I think the kids were a little more excited about the business than Mom was sometimes.”

A Leading Force

After five years, EZPEDO is the leading force in the production of esthetic Zirconia pediatric crowns, but they’re not finished yet. “Jeff and I had this discussion a little while ago,” says Hansen. “Our revolutionary product has changed the face of pediatric dentistry. Pediatric dentistry had basically been the same for a very long time, and we’ve created a huge movement in a very short amount of time. We want to do that again. We want to create the next revolutionary product for pediatric dentistry. There is more to come, for sure.”


Whenever you’re changing an industry and bringing something brand new to the profession, the enormity of the task can be over-whelming, and half the time you don’t even know where to start.

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PLANNING FOR THE FUTURE Hansen and Fisher discuss the future of EZPEDO as the need for advancement continues to grow.

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From practicing dentistry and anesthesiology to creating an industry-revolutionizing product, John Hansen and Jeff Fisher remain as focused on their initiative as the day they began their journey. The two can now look back on what they have accomplished as groundbreaking innovators. “When you look back at things, it’s always a lot more nostalgic as you remember all the good times, and all of the difficulties tend to fade in comparison,” Fisher reminisces. Though, in essence, they are still a young company, so much more lies on the horizon for EZPEDO. With several patent-pending products, Dr. John Hansen and Dr. Jeffrey Fisher aspire to continue leading the way into the future with more innovative and revolutionary products to enhance the art of pediatric dentistry.


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EZPEDO Magazine - Fall 2015  

A Pediatric magazine for both Doctors and Parents to stay up to date with the world of Pediatric Density.

EZPEDO Magazine - Fall 2015  

A Pediatric magazine for both Doctors and Parents to stay up to date with the world of Pediatric Density.

Profile for ezpedo