Page 1

shıft» I S S U E S




FIRST LOOK @ Shift Magazine



Taking time to meet the dental needs of the remote jungle region of Rurrenabaque, Bolivia


A New Beginning How branding affects trendsetting in the field of pediatric dentistry


and an Amalgam Carrier in My Hand

A look at the pros and cons of mineral trioxide aggregate



Digital Noise How to grow your dental practice in a high-tech age










www. sp r i g u m / S pr i n g 2 01 7


Table of Contents

21 L I F E I S G OO D Providing the Best for My Patients.

22 A REAL TOOTH SAVER How Our Daughter Almost Lost Her Beautiful Smile.



Strategies for Competing in Dentistry's Shifting Marketplace.

30 DRILLING THROUG H THE DIG ITAL NOISE How to Grow Your Dental Practice in a High-Tech Age.


Sh i f t mag az in e / Sp rin g 201 7





Providing the Best for My Patients.

A Look at the Pros and Cons of Mineral Trioxide Aggregate (MTA)–an Up and Coming Superstar for Vital Pulp Therapy.

How Our Daughter Almost Lost Her


Beautiful Smile.

Pages 26–28 H OW TO D EVELOP A COM PEL LI N G B RA N D BY RE MINGTON TONAR, MA, M S Strategies for Competing in Dentistry's Shifting Marketplace.

Pages 30–35 D RI L L I NG TH ROU GH TH E D I GI TA L N O I S E BY C E ARA MIL L I GAN, B S How to Grow Your Dental Practice in a High-Tech Age.

42 A BRAND NEW BEGINNING How Branding Affects Trendsetting in the Field of Pediatric Dentistry.

Pages 36–41 SU N, SA ND, & A N A M A LGA M C A R R I E R I N M Y H A ND BY JAROD J OH NS ON, DDS A Look at the Pros and Cons of Mineral Trioxide Aggregate (MTA)–an Up and Coming Superstar for Vital Pulp Therapy.

Pages 42–48 A BRA ND NEW BEGI NNI NG BY AL AN S I E GE L , B A How Branding Affects Trendsetting in the Field of Pediatric Dentistry.

Pages 52–63 U NTO TH E L EAST OF TH ES E BY PAT RIC I A RIVAS , DDS , GAB R I E LLA GARC I A, DDS , J E F F RE Y P. F I S H E R , D DS Taking Time to Meet the Dental Needs of the Remote Jungle Region of Rurrenabaque, Bolivia.

52 U NTO THE L EA ST OF T HESE Taking Time to Meet the Dental Needs of the Remote Jungle Region of Rurrenabaque, Bolivia.

www. sp r i g u m / S pr i n g 2 01 7



Sh i f t mag az in e / Sp rin g 201 7


www. sp r i g u m / S pr i n g 2 01 7



Sh i f t m ag az in e / Sp rin g 201 7


www. sp r ig u m / S pr i n g 2 01 7


Contributors Jarod Johnson, DDS

Aubree’s Parents

Dr. Jarod Johnson, earned his Bachelor of Science in biomedical engineering and Doctor of Dental Surgery from the University of Iowa. He recently completed a certificate in pediatric dentistry at The University of Nevada, Las Vegas, School of Dental Medicine. He is currently working in private practice in Muscatine, Iowa.

Aubree's parents represent countless other moms and dads who stress over their children's dental care. They now take pride in their daughter's princess teeth restored with Zirconia Crowns.

Sarah Mathias, DDS, MS

Remington Tonar, MA, MS

Dr. Sarah Mathias is a board certified pediatric dentist with a practice in Laguna Hills, Calif. She completed her DDS degree at the University of Iowa, eventually earning a master’s degree in oral sciences and a specialty certificate in pediatric dentistry. When not in the office, Dr. Sarah enjoys spending time with her husband, Dr. Bobby Ghandehari, an orthodontist, their sons, and Hans, their German shepherd rescue puppy.

Remington Tonar is a partner at Brandsinger, a NYC-based consulting firm. He previously served as one of the top strategy consultants at Siegelvision, a branding firm founded by marketing luminary Alan Siegel. He holds Master’s degrees in corporate and organizational communication (New York University) and in theology (Loyola University Chicago).

Ceara Milligan, BS

Alan Siegel, BA

Ceara is a digital strategist at Gogeddit, a small-business growth agency headquartered in Milwaukee, Wis. She has extensive experience developing digital and brand strategies and inspiring creativity across all channels and touchpoints. Ceara graduated cum laude with a BS in business administration from Marquette University.

Alan Siegel is one of the bestknown figures in the branding industry and a longtime advocate of clarity and simplicity in business. Alan is also the founder and chairman emeritus of global branding agency Siegel+Gale, one of the most respected branding firms in the world.

Patricia Rivas, DDS Gabriella Garcia, DDS Jeffrey P. Fisher, DDS Dr. Patricia Rivas, trained as a pediatric dentist in Columbia and has practiced dentistry in the U.S. for 13 years. Dr. Gabriela Garcia is currently a dentist at Sanatorio Adventista del Plata in Entre Rios, Argentina, and volunteers six months a year in various South American countries, most recently in Bolivia. Dr. Fisher is a co-founder of Sprig Oral Health Technologies, Inc. [EZPEDO] and is the editor of Shift magazine.

ON THE COVER COVER DESIGN BY MARK BOND PHOTOGRAPHY BY SLAVA DANILIUK DENTISTRY BY LEVI PALMER, DDS Our first issue of Shift magazine features Aubree on the cover. On page 22, her parents tell the story about how their beautiful little girl almost lost her smile and how a pediatric dentist from Chico, California, restored her teeth and gave her the confidence to thrive.


Sh i f t m ag az in e / Sp rin g 201 7


Technology + Design Inspired by our frustrations as practicing dentists, we’re constantly developing new technologies and design features to ensure our products remain the most advanced and trusted solutions on the market. Our technologies are designed for dentists by dentists to conquer real world clinical challenges. Our Zir-Lock retention technology uses a patented design to increase mechanical adhesion. Our Flat-Fit design saves space and reduces risk of pulp exposure. And, our patent-pending ASAP preparation system using EZPrep burs enables faster seating and reducing chair time while minimizing tissue trauma. Together with our use of both computer-aided and hand-finished design, these features continue to make our crowns the go-to choice for dentists nationwide. Learn more at

www. sp r ig u m / S pr i n g 2 01 7





S H I F T M AGAZINE Vol. 3 No. 1 | Spring 2017


PUBLISHER Sprig Oral Health Technologies, Inc.

Has anyone ever asked you the following rhetorical question? “Who do you think you are?” Although the question is often used in a derogatory way, the reality is that this question is actually quite significant. Many of us have never given such an inquiry much thought, but the truth of the matter is, the question is vitally important. Every individual, practice, and company should take time to ponder/evaluate/consider it. Who am I? What core values have I chosen to guide my life? How do I want my patients to view me and my practice? How we answer these tough questions is critical in determining the success of our lives. Our identity. Our purpose. Our vision. These intangibles are the threads that, woven together, make up the fabric of our lives. Simply put, they are the sum of “who we think we are.” You know our company, EZPEDO, as the maker of the best looking kids’ crowns on the market. We imagine and create groundbreaking oral health products for children. Building on this reputation, EZPEDO is excited to announce that we have made a strategic and dramatic move to rebrand our company. As we transition from EZPEDO to Sprig Oral Health Technologies, we want to present a clear and simple message of who we are. • We are trailblazers who are disrupting the field of dentistry to make a positive impact. As the pioneer oral health technology company, we are consistently pushing innovation boundaries and challenging the status quo. • We are empathetic to our customers. Empathy is critical in the field of healthcare. We understand families’ needs and we design our products to meet those needs. We want to make pediatric dental care painless and convenient for parents and children alike. • We are confident about the future of dentistry. There is no doubt that our products are best in-class. We consider ourselves pioneers and thought-leaders in the field of dental technology. We are assured that technology will fuel growth and progress in pediatric care. • We are innovative, constantly improving our products and adapting to patient trends. To stay ahead of the competition and to provide patients with the best care possible, we are continually looking ahead, anticipating how to create the “next best thing” in oral health.


6140 Horseshoe Bar Road, Suite L Loomis, CA 95650


+1 (888) 539 7336


+1 (916) 677 1447



M AG A ZI N E STAFF J E F F RE Y P. FI S H E R , D DS Editor-in-Chief JAME S F IS H E R , M S PH , Ph D Senior Consulting Editor ANN F I S H E R Copy Editor DANIE L VAKA RYU K Art Director T IMOT H Y S H A M B R A Senior Designer

CO N TR I B UTO RS Sarah Mathias, DDS, MS Elizabeth Chen, DDS Aubree’s Parents Remington Tonar, MA, MS Jarod Johnson, DDS Ceara Milligan, BS Alan Siegel, BA

So, who is Sprig Oral Health Technologies? We are a cutting-edge technology company determined to be the compelling force that continues to revolutionize pediatric dentistry with the innovation both patients and professionals demand. People think of dentistry as tired, old, and stale—and in many cases, they’re right! In our age of technology and innovation, we believe that the next generation deserves next generation care—and that together, we can make it happen. You will notice that our magazine has a new name—SHIFT. This name change reflects the impact that EZPEDO has generated in the field of pediatric Dentistry and the dramatic changes that have occurred over the past decade. These changes—the revolutionary use of Zirconia crowns in place of SSCs, the transition from using formo to using MTA, and the radical modification from simple “yellow pages” advertising to social media marketing—are all exciting examples of the shift taking place in our profession that propels dentistry forward to achieve better patient care. Our guiding vision at SHIFT magazine is to provide you with inspirational stories, scientific research, and educational content that will both inform and motivate you to greater heights of professional achievement. And remember, I’d love to hear your thoughts and comments not only about the articles in this issue of Shift magazine, but also about EZPEDO’s transition to Sprig Oral Health Technologies, Inc. So drop me a line at

Levi Palmer, DDS Patricia Rivas, DDS Gabriella Garcia, DDS Jeffrey P. Fisher, DDS

DI G I TA L ED IT IO N For new subscriptions, subscribe at For all other reader services, including letters to the editor, write to

Jeffrey P. Fisher, DDS Editor-in-Chief 10

Sh i f t mag az in e / Sp rin g 201 7


Faster. Healthier. Smarter. Sprig’s fast-set MTA is designed specifically for pediatric dentistry. SmartMTA sets in only three minutes (not hours like other brands), so you can place, prep and restore in the same visit. SmartMTA causes no discoloration even in the presence of blood contamination and is designed to tackle mixed-dentition cases, primary and permanent teeth, bases, caps, pulpotomies and pulpectomies. At Sprig, we believe that our next generation deserves safe, natural products. Made from biologic ingredients and no heavy metals, SmartMTA gives dentists and parents a smarter choice. Learn more at

www. sp r i g u m / S pr i n g 2 01 7





Meet BirdEye

BirdEye is a reputation marketing platform that makes it easy for practices to get positive reviews and amplify their good reputation everywhere. Control your reputation and get more patients by generating positive reviews from satisfied patients on sites like Google and Facebook today. GET NEW REVIEWS AUTO PROMOTE YOUR BEST REVIEWS MANAGE NEGATIVE REVIEWS RANK HIGH ON GOOGLE AHEAD OF YOUR COMPETITORS For more information, contact Birdeye, Inc. 440 N Wolfe Road, Sunnyvale, CA 94085. (800) 561-3357 |


Weave offers a full patient communication solution, including full integration of your office phones. This means your phones are connected to your practice management software/EHR, creating a more efficient, more helpful, smarter patient interaction. TWO WAY TEXTING SMARTPOP (Instant, contextual patient data) AUTOMATED RECALLS AND REMINDERS CALL REPORTS CALL RECORDING DYNAMIC PATIENT TASK LIST PATIENT BALANCES AND INSURANCE INFO PHONE SERVICE REVIEWS MOBILE APP For more information, contact Weave. 3401 North Thanksgiving Way #400, Lehi, UT 84043. (888) 545-8880 | 12

Sh i f t mag az in e / Sp rin g 201 7


Simple and Superior Hemostasis Sprig’s HemeRx retraction pellets deliver simple and superior hemostasis management for pediatric restorative procedures. Hemostasis is paramount to the long-term clinical success of Zirconia and strip crowns, subgingival composite restorations, and pulp therapy. Whatever the procedure, HemeRx provides essential retraction plus unmatched hemostasis for less stress and better results. Simply moisten and place. HemeRx is also kid-friendly, and doesn’t leave that notoriously awful taste in kid’s mouths, making it the perfect solution for pediatric patients. Learn more at

www. sp r i g u m / S pr i n g 2 01 7




Sprig crowns are meticulously designed, thoughtfully engineered and precision hand-crafted right here in the USA, but it’s the remarkable innovations built into every one of these crowns that truly place Sprig in a class of its own.



Sh i f t mag az in e / Sp rin g 201 7

EZPREP Diamond Bur System

The Best Tools for the Best Crowns Increasing speed and efficiency while reducing operator error are paramount to successful crown preparation. That’s why we designed our own diamond bur system with a novel, axial depth-cutting feature that gives dentists the right amount of reduction every time. Our EZPrep diamond bur system is the only system specifically designed for fast and accurate Zirconia crown preparation. With unique cutting capabilities that respond to real clinical challenges and diamonds specifically selected for use in precision cutting instruments, our burs are critical to making Zirconia work for your practice. Learn more at

www. sp r i g u m / S pr i n g 2 01 7




EZPEDO Symposium 2016

David Rothman, DDS

Vance Merhoff and Tina Merhoff, DDS

Elaina, Cathy Jameson and Brenda Hansen


Last years EZPEDO Annual Symposium was held on the property of the Ritz-Carlton in beautiful Lake Tahoe, California. Cathy Jameson, PhD and David Rothman, DDS were guest speakers and presented on engaging and relevant topics in the field of pediatric dentistry.

Cathy Jameson, PhD

Harry Hall Sumner and wife Trice Sumner, DDS


Sh i f t m ag az in e / Sp rin g 201 7

Andrea Igowsky, DDS and husband Ben


Vicki Sullivan, DDS and her daughter Madeline


It was an absolute joy to spend quality time with familiar faces and have the oppurtunity to meet new friends. We cant wait to see you next year, and discuss the future of pediatric dentistry.

Jamie Marchi, DDS and Trice Sumner, DDS

Andrea Igowsky, DDS

Cheryl Cooper, and husband Sean Cooper, DDS

John and wife Cathy Jameson, PhD


Vanessa Hurt

Kent Hallmeyer and wife Sandy



myconfidence. Sprig [EZPEDO] Zirconia crowns are the best Zirconia crowns on the market! They have the most natural shape and color compared to other brands, and they are the easiest to seat. I don't have to buy any special equipment or products for my Sprig [EZPEDO] Zirconia crowns. They bond easily with my pure GI cement that I use with all my stainless steel crowns, and I don’t have to bother with annoying try-in crowns. The space-loss crowns o er a lifesaving option when facing crowded conditions in the posterior. I have been amazed with the durability and craftsmanship of both the anterior and posterior crown collections. I have experimented with the di erent Zirconia options and discovered that Sprig [EZPEDO] crowns are the easiest to place and the most natural looking. Parents agree and are always pleased with the realistic and natural look. We will continue to exclusively use Sprig [EZPEDO] crowns.

20660 Westheimer Pkwy, Suite A, Katy, Texas 77450 281-579-8700 |


Sh i f t m ag az in e / Sp rin g 201 7

DOCTOR TO DOCTOR A pediatric dentist with a private practice in Katy, Texas, Dr. Elizabeth Chen comes from a family of dental professionals. Every member of her immediate family is a dental specialist. Dr. Chen is an avid soccer player and a proud user of Sprig [EZPEDO] pediatric Zirconia crowns.

www. sp r ig u m / S pr i n g 2 01 7



Sprig [EZPEDO] has more experience teaching doctors how to use pediatric Zirconia crowns than any other company. After all, we invented them nearly a decade ago. Since then, we’ve continued to advance our products, how they’re used, and how we teach others to use them. Sprig University courses are designed to help you master our easily repeatable approach to tooth preparation using the industry’s highest-rated pediatric Zirconia crown, all while earning 8 CE units at a destination of your choice.



EST. 2013

Join Us

online at

Register online at




hen I graduated from residency in Chicago, I had a vision of being able to provide the highest quality care in a setting that would actually make children happy to visit the dentist. After spending time learning from some great mentors in a variety of practice settings, I was ready to make my vision a reality. In 2004, I started my own practice, Jungle of Smiles, in South Orange County, California. We were one of the first paperless offices. I know that doesn’t seem very exiting now, but it was cutting-edge practice at the time. We took digital radiographs, and designed an environment that rivaled the ambiance of Rainforest Café. But every day I practiced, I faced the same look of horror on parents’ faces when it came time to discuss the dreaded stainless steel crown. The worst part about those discussions was that I had nothing better to offer that would improve the situation. As the years passed by, various manufacturers attempted to market products that would remedy the situation. And I tried them all. The results proved less than fantastic. Frequently, they induced profanity on my part while attempting to place them, and no one was happy when all the white facing disappeared sooner rather than later.

than a little doubt in my mind. I was thinking, “I’m going to spend a couple grand on a box that will gather dust in the back of my operatory.” But in the end, I decided to give EZPEDO [SPRIG] crowns a try. I made the decision largely based on the recommendation of my anesthesiologist who told me, “My friend is the one who created these great crowns.” After placing my first EZPEDO [SPRIG] crown, I was extremely pleased with the results. So were the parents of my patients. But, I still was not convinced. What if the crowns broke, or came off? There had to be a catch. I waited for the phone call, but none ever came. Success! I continued to place more crowns, becoming more and more confident that there really was an esthetic, durable, and reliable crown option available for children. Over the past several years, I have placed hundreds of EZPEDO [SPRIG] crowns. My favorite experience with them is when a patient comes in, and I don’t even realize the tooth I am examining is a crown. Then I look at the x-ray, and realize it is not their natural tooth. That is how esthetic these crowns have proved to be. I am happy to finally have a crown that matches my vision for optimum patient care.

So, in Orlando at the AAPD annual session in 2014, I found myself standing at the EZPEDO [SPRIG] booth, with more

S h i ft mag azin e / S pr i n g 2 01 7


By Aubree’s Parents

In June 2016, our daughter Aubree had an appointment at a nearby hospital where the dentist had scheduled to treat her under anesthesia. Our appointment was originally scheduled for 7 am. Due to a scheduling mix-up, our appointment was changed to 1 pm. Aubree wasn't allowed to eat anything all morning. The stress was getting to me, but finally the time came for her surgery. The doctor said that they were going to take x-rays while she was under anesthesia and would call me after the x-rays had been processed. A little later, I got the doctor’s call. He stated that he wanted to pull all six of her bottom teeth, cap the four top teeth with white caps, and give her silver teeth in the back. I didn't have anybody there for support because my husband was at work. I was devastated, upset, and confused, with no idea what to do next.

I was just getting off work when I received a phone call from my wife who was in a panic. After hearing what the dentist wanted to do, I said, “Absolutely not, and don’t do anything until I get there.”

I was so stressed out because my daughter was lying there in bed under anesthesia, and the doctor was pressuring me to make a decision right away.

Once I got to the hospital, the doctor told us that if we didn't have the procedure done that day, they would take her off anesthesia, and we would never be seen by them again. I told them, “Wake her up.” We waited for the anesthesia to wear off and left. From this point on, we felt extremely stressed. Although we knew our daughter needed the dental work, we wanted it to be perfect and wanted her to have white teeth without a single silver cap.


Sh i f t mag az in e / Sp rin g 201 7


www. sp r ig u m / S pr i n g 2 01 7


I kept second-guessing myself and wasn't sure if we had made the right decision. But a couple weeks later we found Dr. Levi Palmer, and he informed us that he would be able to fix Aubree’s teeth and restore her beautiful smile again without pulling any teeth.

We looked on Dr. Palmer’s website and discovered he did amazing work. He informed us that Aubree didn't need to have any of her teeth pulled, and there was no reason that she should have silver caps. He told us about Zirconia crowns that would look totally natural and assured us that no one would ever know she had them.

I'm so impressed with the work that they did and am so incredibly grateful that we made the decision to take our daughter off the anesthesia and find another doctor.

Aubree’s teeth were treated with Zirconia crowns the way we wanted without pulling a single tooth or having any silver in her mouth. We are extremely happy with the outcome and so thankful we discovered a natural-looking Zirconia option in time for her treatment. Aubree now proudly displays what she calls her “princess teeth” for all to see.

ABOVE: Aubree enjoys time with her dad flying like an airplane. BELOW: Mother and daughter share a special moment together looking at pictures. 24

Sh i f t m ag az in e / Sp rin g 201 7


THIS PAGE: Mom and Dad enjoy a hug with their little princess. Aubree is so excited that she now has a smile which enables her to share her beautiful princess teeth with the world. DR. PALMER SAVES THE DAY: Dr. Palmer was able to stabilize Aubreeʼs teeth with the use of silver diamine fluoride (SDF) to maximize the prognosis for her four front teeth and decrease the sensitivity that Aubree had been complaining about. Mom was a little freaked out with the black color, but a few weeks later, Aubreeʼs teeth were restored with Sprig [EZPEDO] Zirconia crowns and today look amazing.

www. sp r i g u m / S pr i n g 2 01 7



S h i f t mag az in e / Sp rin g 201 7




Strategies for Competing in Dentistry’s Shifting Marketplace By Remington Tonar

Dentistry, as with other areas of the healthcare industry, has been subject to recent sweeping changes. Today’s rising business costs and shifts in the insurance industry are driving the proliferation of ever-bigger group practices. The democratization of information is also empowering patients and fueling healthcare consumerism. Increasingly expensive care is forcing a growing number of uninsured, out-of-pocket payers to be more selective in their choice of dental care. The situation is further compounded by the fact that both an aging population and an expanding demand for pediatrics are dramatically changing the patient pool in dentistry. These tectonic shifts are making dentistry as a whole more competitive, forcing practices to take marketing more seriously and to evolve how they engage existing and

prospective patients. This challenge is especially acute for solo practitioners and small offices that don’t have the marketing dollars that larger group practices enjoy. Unfortunately for smaller practices, an ad in the local Yellow Pages or a billboard on the highway are no longer enough to attract and retain today’s patients. The days of build-itand-they-will-come dentistry are over. Dental practices that want to thrive in the 21st century will have to follow the lead of many hospital systems across the country and invest more time, energy, and financial resources into building their brand. While many dentists understand the importance of marketing, many don’t understand how to effectively build a brand and take it to market. After all, only a handful of oral health companies have managed to become household names, and even then they’re usually owned by

conglomerates like Procter & Gamble and Johnson & Johnson. Creating a strong brand is even more difficult for local practices that have a fixed geographical reach and offer nearly identical services to those of their competitors. Whether you run a solo practice, a group practice, or even a dental products company, there are ways to develop a compelling brand that can help you stand apart and more effectively attract and retain new business. First, however, it’s important to understand what a brand is and what it is not. While the word “brand” is often associated with products, companies themselves have brands, too. A corporate brand is the manifestation of who an organization is, how it’s different, and why it’s valuable. It’s much more than just a logo or a tagline. It must be both expressed and experienced,

www. sp r ig u m / S pr i n g 2017



It’s much more than just a logo or a tagline. emerging in what you say and what you do. For dental practices, this means not only saying you’re different, but showing it through the way you interact with patients, the way you design your in-office environment, and even in the value-added services (e.g. patient education and community outreach) you choose to offer. To create a brand that can own local markets, dental offices must first determine how they are greater than the sum of their parts and what unique value they bring to their patients. What do you have that others don’t? What can you do that others can’t? What are you willing to do that others won’t? What are you trying to accomplish that others aren’t? What perspective or attitude do you have that nobody else does? What, beyond financial gain, gets you up in the morning? Beyond determining how your brand can leverage its capabilities


Sh i f t m ag az in e / Sp rin g 201 7

and personality to differentiate your practice, it’s also important to understand what your market needs. Many dentists understand high-level industry trends, but chasing these trends blindly can be disastrous for your brand. For example, increasing dental demands among baby boomers has led many practices to double down on geriatric services. This groupthink, however, creates a pediatric dental vacuum in local markets at a time when millennials are finally starting to have kids in increasing numbers. Thus, the real needs in your particular marketplace may diverge from the obvious demands of the overall market, and it’s critical to be able to distinguish the two. Once you’ve identified who you are, how you’re different, and what your market needs, the next step is to translate that knowledge into a brand strategy that will inform and direct everything you say and do. This strategy usually takes the form of a positioning statement that synthesizes what you’ve learned about your organization and your market. This statement can then be translated into the assets and experiences—the touch points— that people will encounter and

Brands are built on strategies that emerge from who you are and what you can do that’s better or di erent than what others do; they’re more than just clever, memorable logos. The best brands are informed by qualitative and quantitative research that analyzes internal and external needs, capabilities, and trends. Businesses with successful brands incorporate their branding strategy into everything they say and do, from marketing activities, to the services they o er, and even to the way they interact with clients. Management must be committed to adequately funding and enthusiastically supporting a strategic brand-building plan in order for it to succeed.

interact with, e.g. your logo, your website, your office waiting room, your advertising, your community sponsorships, your value-added services, and even your chair-side manner. EZPEDO, for example, is positioning itself as the first true technology company in pediatric dentistry—an industry not known for innovation. To deliver on its claim to hold this position, the company has changed its name and visual identity to reflect a more contemporary, technological personality. More importantly, it is aggressively investing resources to evolve its current product offerings and create a variety of new techinspired products for pediatrics. Undertaking a rebranding effort is not an easy task. It can be time consuming, pricey, and even contentious. The dental profession is becomes increasingly competitive and consumers (your patients and their parents) are continuing to become more discerning and demanding. In light of this reality, having a strong brand that can generate awareness and trust between you and the people who matter the most to your business will become ever more critical.


W W W.T W I T T E R . C O M / S P R I G U S A

W W W. FA C E B O O K . C O M / S P R I G U S A

W W W.Y O U T U B E . C O M / S P R I G U S A

(888) 539.7336

www. sp r ig u m / S pr i n g 2 01 7




Sh i f t mag az in e / Sp rin g 201 7


HOW THE CURRENT DIGITAL REVOLUTION AFFECTS YOUR PRACTICE The digital revolution we are currently experiencing has drastically changed the way in which people engage with one another and with businesses. This revolution is perpetually revamping the world of marketing while rendering many traditional advertising channels and strategies obsolete. Today, people communicate, shop, and research much differently than they did even a decade ago. The “old” way of doing business in any industry is now unsustainable. Even medical and dental practices—typically longstanding stalwarts of a community—must constantly re-evaluate the ways in which they engage and communicate with their patients. As a dentist, you profoundly impact people’s lives and their health. Your patients are seeking brighter, happier, healthier smiles. People visit the dentist because they want to take care of themselves, boost their self-confidence, and feel more comfortable. People yearn for an exceptional experience when they enter and exit your office doors. How can you engage them most effectively in a digital age?

www. sp r i g u m / S pr i n g 2 01 7



THE DOMINANT IMPACT OF A DIGITAL GENERATION Adults in the United States devote an average of 10 hours and 39 minutes to digital media and check their smartphones over 150 times each day. By now, we are all well aware that anything digital is dominating the marketing game. Although technology supposedly makes our lives easier, we discover that navigating new methods of social media and dealing with digital marketing can be confusing and complicated. One of the deepest desires of today’s dentists seeking to create a successful brand is to cut through the digital noise, not simply be part of it. Dentists searching to build a brand must face this new technological reality and adapt in order for their practices to thrive in years to come. A major component of success is being able to attract the rising millennial audience. Yes, millennials are the “entitled” generation that has been criticized for living in their parents’ basements, for being “lazy,” and for making less income while taking on more debt than their predecessors. However, they’re now growing up and starting families. Although they may not have adopted the most economical saving habits, providing them with the discretionary income their parents had, they are very health conscious. They are willing to spend disproportionate amounts of their income on health care, making them a vital consumer of pediatric services. So how do you attract this new wave of customers while not alienating your long-time base? The keys to success are developing a compelling brand and selecting the right digital platforms. We will explain each of these in detail below.

DEVELOPING A COMPELLING BRAND It is crucial to create a brand that speaks to your audiences in a clear, uniform way. The channels on which your brand is presented, both offline and online, must coexist seamlessly in order to gain recognition, trust, and loyalty. In today’s cluttered world, your brand must have a strong identity and establish both authority (“being the trusted expert”) and empathy (“understanding your audience”). This can be done by positioning your brand as the “guide” and your customers as the “hero.” In other words, put your patients at the center of your brand messaging instead of constantly talking about how great your practice is. Many brands struggle with this, so if you can evolve your messaging to be more patient-centric, you can create a huge competitive advantage. To get started, you must have a solid definition of your brand. More importantly, your customers should have a clear understanding of who you are and what you stand for. When someone first comes into contact with your brand, they should immediately be able to tell—very simply—who you are, what you stand for, and how you will make their lives better. While developing your brand online is important, keep in mind that your in-office experience should be just as memorable, inviting, and seamless. If your brand is friendly and inviting, a customer walking into your dental practice should be met at the front desk with someone who exudes that type of persona. Your brand should be consistent, reflected in everything from how your storefront and staff look to how the phones are answered and how patients entertain themselves in the waiting area.

Your brand must have a strong identity and establish both authority and empathy.


Sh i f t M agazi ne / M ay 2017

Questions to ask when developing a brand-building plan: • • • •

What do we stand for? Who is our target audience? What problems are they facing? What are their aspirations and passions?

• •

What is our competitive advantage? How can we solve their problem(s) better than the competition? How do we want people to feel when they do business with us? What is our brand’s voice? (How do we “walk and talk?”)

• •

Consistency in implementing your brand can make or break a patient’s overall experience with your dental practice. From the moment they hear about you to the moment they take a seat in your dental chair, everything about your brand is communicating to them who you are and what it’s like to do business with you. Take time to assess if your current brand is working and communicating the way you want it to. Authentic and transparent communication is key, especially in the world of healthcare, where people’s health and wellbeing are paramount. When you have a successful and compelling brand, your digital efforts will prove much more effective in growing your practice.

SELECTING THE RIGHT DIGITAL PLATFORMS Facebook, Google, LinkedIn, email, print, radio, Instagram, direct mail, Snapchat, your website, Pinterest—the list goes on. It’s 2017, and the options available to market your business are seemingly endless. As a dental practice, you also don’t have the time and resources that larger corporations do. This makes it even more important to invest in the correct platforms. Many small businesses try to have a presence on too many platforms and end up spreading themselves thin, thus not getting the results they desire. So where do you start? Go where your target audience is already spending time and where you can engage and add value to their experience. For most dental practices, this means having an effective website and utilizing Facebook, Instagram, email marketing, and review sites. We will focus on these options in the rest of this article.

Creating a Website That Drives Action With 97% of consumers searching for local businesses online, today your website is more important than ever. It should serve as your online storefront and should be mobile optimized, stress simplicity, and clearly call visitors to take action. The design should be simple, easy to navigate, and provide just enough information to get your main message across. According to today’s Web standards and best practices, brevity is key. If site visitors land on your page, and cannot figure out exactly who you are, how you can make their lives better, and how to contact you in a matter of five seconds, you should re-evaluate your homepage. While navigating your website, visitors should have a great sense of how you’d be able to make their lives easier. Establishing a sense of empathy through aspirational imagery and compelling copy allows your audience to develop trust in your brand’s message. Your website should also display multiple, crystal-clear calls-to-action. The most obvious action you want your customers to take is to schedule an appointment with one of your doctors. Place a “Schedule an Appointment” button prominently on your homepage (center and top right) and throughout your site. In reality, customers do not take action on their own. They must be repetitively and comprehensibly guided to do so. Remember that all content on your site should have a purpose. It should build credibility, show empathy, and guide your visitors to book an appointment and interact with your brand. Establishing

your position as the go-to local dentist should be a top priority. Once patients are comfortable and happy with their dentist, they will usually stay with the practice unless they move to a new area. It’s important to ensure your practice is visible in search engines for local search terms. Local search engine optimization (SEO) efforts will help boost you to the top of search engine rankings.

Facebook: The Best ROI for Small Businesses With 1.86 billion active users and the average U.S. consumer spending over 40 minutes per day on the network, Facebook is a great place to reach your target audience and market your practice. However, only 45% of marketers think that their Facebook efforts are effective. This shows that although your audience is on Facebook, you may be struggling to engage your audience and attract new customers to your site. Your dental practice’s Facebook page should establish your brand as an authority and foster a community through compelling content and informational posts. For example, you can share case studies, articles from esteemed trade publications, helpful tips, customer testimonials, and fun holiday wishes. (Note: National Dentist’s Day is March 6.) With Facebook, you can reach a variety of people with one post, create ads to drive traffic to your website, foster dialogue with your customers, share your brand’s story and testimonials, and provide detailed information about your practice

Facebook Video Is on the Rise Over 100 million hours of video are watched each day on Facebook, and that number will continue to rise exponentially. Utilizing video on Facebook is another great way to boost engagement. With its own video and live-stream platforms, Facebook is set to own the online video world in coming years. Video adds value and variety to your audience’s news feed. Facebook videos, like regular posts, should be engaging, yet brief. With so many items flooding users’ news feeds, your followers’ attention can be diverted elsewhere fairly quickly if your videos are too long.

Facebook Dollars Are Invaluable Many modern businesses have been asking, “Do we have to pay to play on Facebook? If so, how much?” Back in 2009, Facebook released Business Pages. From then until 2012, businesses enjoyed the free-for-all of 100 percent organic reach, meaning that if you had 500 fans on Facebook, all 500 of those people would view your post for free if they were online! Today, that organic reach has plummeted down to about 2 percent. That said, after working with hundreds of small business owners over the last several years, we can confidently say that “Paid Facebook” can be the best return on investment (ROI) for small businesses. And you don’t have to pay a lot to make an impact. Many of our small business clients do well with a $50– $200 monthly Facebook budget. Over the past few years, Facebook ads and increased numbers of posts have become key drivers of ROI for brands with a presence online. Putting money behind your content can greatly amplify its reach. Additionally, when people engage with your ads (e.g., liking, sharing, commenting), your content will gain exposure to an even larger audience. Businesses can target users with very specific attributes, such as location, age, gender, interests, education level, behaviors, and connections. For example, you can create an ad for your dental practice that is specifically targeted towards 30- to 40-year-old women who have young children, live within 10 miles of your office, commute to work every weekday, own a smartphone, and enjoy drinking coffee. Crafting the right messages for your target audience at the right times can grab your patients’ attention and result in one appointment after another.

Execution Pro Tips: •

Production Pro Tips: • •

Keep it brief: 15-second to 2-minute videos are the ideal length. Use subtitles: Facebook videos start playing automatically on mute when a user scrolls through their news feed. If subtitles are added, the user is more likely to start watching the video, resulting in increased engagement. Keep it real: High production videos are great, but don’t sweat if your videos are “scrappy.” Videos recorded on a smartphone work well and sometimes even get more engagement on social media since they are so raw and authentic.

Target very specifically: The more specific you can be the better. Consider using “lookalike” audiences, retargeting, etc. Use compelling imagery: Make sure the photos, graphics, or videos used in your Facebook ads speak to the target audience and represent the message you are trying to get across. Always test, monitor, and adjust: One of the great things about Facebook ads is that you can pause and adjust them in real time. Try running multiple ads in the same campaign, see which ones are performing well, and play around with the targeting.

www. sp r i g u m / S pr i n g 2 01 7


Email Lives On Contrary to what some people—even marketers—believe, email is not dead. In fact, the use of email marketing is increasing each year. More than 90 percent of consumers still check their email daily, and email is said to produce a better ROI than any social network on highly targeted campaigns. Although people’s inboxes seem to be overflowing nowadays, developing a powerful, effective email strategy can help grow your practice. Email is a great way to communicate with your patients on a consistent basis. Keeping your patients in the loop with reliable, personalized messages builds trust and provides them with another avenue to communicate with your office. Email marketing can be used to notify your patients regarding practice updates, special offers, industry news, and other relevant, interesting content. You can also send individual emails to patients reminding them to schedule their next appointment. This will establish a loyal patient-dentist relationship. There are a number of ways to grow your email subscriber list. Encourage your patients to sign up for your email newsletter on your website by offering them something of value, such as a special discount, free dental health tips, or branded products merchandise. (Someone could probably use a new toothbrush!) It is also very important that you collect your patients’ email addresses when they schedule an appointment or check in. This is by far the easiest and most effective way to grow your email list.

Instagram: The Hottest Social Network Instagram is a visual social network that is based primarily on photo and video posts. The Facebook-owned network has more than 600 million active users worldwide, with more and more users joining every day. Of these viewers, 75 percent take an action, such as visiting your website, after viewing an Instagram post. Visual content sparks the mind and fuels engagement. The benefits of Instagram in the dentistry field include attracting new patients and referrals, increasing traffic to your website, and fostering brand engagement. Visual images communicate quickly and conveniently. An added benefit for dental practices (and other healthcare organizations) is having the power to humanize care and to create an emotional connection with the audience.

A New Way to Tell Stories In July 2016, Instagram launched Stories, an ephemeral photo and video feature very similar to Snapchat. Stories are temporary (24hour lifecycle) photos and videos that are strung together to form a slideshow gallery that tells a story your followers can view and enjoy. You can also display live videos within Stories. Similar to how Facebook’s live video feature works, your followers receive a notification within the platform that your brand is live.

Why you should take advantage of Instagram Stories: •

• •


Placement: Whenever you share an Instagram story, you will appear in the top bar of the user’s feed. Authenticity: People love consuming content in short video clips, such as behind-the-scenes looks at your practice. Creative flair: Stories allow you to get creative and add text, stickers, filters, and other add-ons to photos and videos.

Sh i f t m ag az in e / Sp rin g 201 7

A simply designed email with just a few main sections will grab your subscribers’ attention better than a long-winded email with an abundance of information. Be sure to have a purpose for each email you send along with a crystal-clear call-to-action, whether that is to schedule an appointment, attend an event, or redeem an offer.

Consumers Depend on Reviews Before making a decision on which business they’ll buy from, many of today’s customers turn to review sites. In fact, 88 percent of consumers trust online reviews as much as they trust personal recommendations. They will “shop around” online to read about other people’s experiences with various offices. Chances are, if people are speaking highly of your brand, their actions will inspire others to place an initial trust in you. Ideally, readers of these reviews will test your product and service, and if things go well, they will also become customers and leave positive reviews of their own. On the other hand, if someone has a poor experience with an office, they will likely express their negative opinion using one of these online review sites. It’s important to make it a habit to frequently monitor and update your practice’s page hosted at online review sites like Yelp and Google. ZocDoc and Healthgrades are other popular review sites that are specifically designed for the healthcare industry. Patients can also leave reviews on your Facebook and Google+ pages. Be sure to respond to these reviews, whether they are positive or negative.

Conclusion When the elements of your dental practice’s marketing ecosystem work together in harmony, your business will run more efficiently, and your patients will have an excellent experience time and time again. People in today's digital world expect businesses of all types and sizes to utilize up-to-date technologies and to employ effective communication methods. Offices that choose to invest in enhancing their use of technology and building effective digital communication platforms will experience more cost-effective practices, an increase in production, and greater numbers of happier, satisfied patients. You must decide when to embrace these technological innovations, not if.

You must decide when to embrace these technological innovations, not if.

About GoGeddit GoGeddit is a small-business growth agency headquartered in Milwaukee, Wisconsin. Our mission is to help small and midsize businesses find their voice and cut through the digital noise, not just be part of it. We provide services such as digital marketing strategy, brand identity and design, and website development. We understand that going digital can be a formidable obstacle, but we aim to assure our clients that when done right, staying up-to-date in a digital world is always worth the investment. For more information, contact GoGeddit. 2680 S. Kinnickinnic Ave, Unit #1, Milwaukee, WI 53207. (608) 628-3286 |


www. sp r i g u m / S pr i n g 2 01 7



SUN, SAND, AN AMALGAM CARRIER IN MY HAND A look at the pros and cons of mineral trioxide aggregate (MTA)—an up and coming superstar for vital pulp therapy By Jarod Johnson, DDS It all started on a February day when I boarded a plane flying to Las Vegas for an interview at the University of Nevada, Las Vegas (UNLV) School of Dental Medicine. My flight took me through Minneapolis and on to the only location where “the sun goes down but the city gets brighter.” After a short cab ride to the dental school, I was soon seated for an interview. Shortly after we began, Dr. Ron Lemon, graduate program director and endodontist, started talking about “regrowing pulps.” As a fourth-year dental student, I thought this was a trick. I smiled, nodded, and luckily received an offer to enroll in the pediatric residency program despite my ignorance. My time in the sun allowed me to take advantage of everything UNLV’s program had to offer. Although they did not offer an endodontic residency, I quickly discovered that opportunities to perform endodontic therapy in children were plentiful. This sparked my interest in learning the properties of mineral trioxide aggregate and how to handle it clinically in order to best suit the needs of my patients. It took me a few cases to learn how to handle the material, but quickly I realized that the procedures could all be performed using familiar instruments. I’d like to share the knowledge I learned during my time in the sun playing with sand, while holding an amalgam carrier in my hand.

PROPERTIES OF MINERAL TRIOXIDE AGGREGATE (MTA) Mineral trioxide aggregate (MTA) is a bioactive material composed of dicalcium silicate, tricalcium silicate, tricalcium aluminate, and tetracalcium aluminoferrite. Bismuth oxide is added as an agent rendering the material radiopaque and giving it a thickness approximately equivalent to 7 mm of aluminum. 1 This addition gives the material more radiopacity than dentin and gutta percha. As a result, MTA is readily detected upon radiographic examination and ensures proper placement of the material and allows for radiographic follow up. When mixed with water, MTA begins to set and releases calcium ions, which in turn leads to the formation of hydroxy appetite as it combines with phosphate ions that are present in the body. This layer adheres to dentin through a chemical bond as the material sets and provides valuable sealing capabilities. 2 The aggregate material is bacteriostatic due to its basic pH, and has been shown to be an inhibitor of bacterial growth. Recent studies have shown that MTA has potential to entomb bacteria in dentinal tubules as it forms tag-like structures that seal off tubules. This action allows the material to provide a sealing function in many different clinical scenarios. 3,4


Sh i f t m ag az in e / Sp rin g 201 7

MTA can be successfully utilized in primary teeth for indirect and direct pulp caps, pulpotomies, root-end filling (apexification), and perforation repair. In permanent teeth, the uses are even more diverse as they include direct and indirect pulp caps, pulpotomies, root-end filling (apexification), regenerative endodontics, orthograde obturation, perforation repair, and apicoectomy. 5,6

ADVANTAGES Faster Bridging Than Calcium Hydroxide MTA has been shown to exhibit faster bridging qualities than calcium hydroxide. MTA forms a dentin bridge in a shorter period of time than calcium hydroxide. 7 The bridge is detectable radiographically once it is 0.5 mm in thickness. 8 The formation of more tooth structure underneath the material may help provide a better seal against bacterial leakage, which is a common etiology of endodontic failures. 9

www. sp r ig u m / S pr i n g 2 01 7


Bioactive MTA has been shown to stimulate hard tissue formation in contact with vital pulp cells and periapical tissues. Properties of the material stimulate the formation of dentin, cementum, and the periodontal ligament. The capability of the material to be osteoinductive when used in different tissue environments accounts for MTA’s wide variety of uses in vital and non-vital pulp therapy in both permanent and primary teeth. 5


Biocompatible Unlike calcium hydroxide, MTA does not induce a layer of coagulative necrosis which results in hard tissue formation. As noted above, MTA has been shown to be compatible with pulp and periapical tissues when routinely placed in contact with them during therapy. 7 Unintentional extrusion of MTA out of the apex has been documented in the literature, and while not advocated, it has resulted in tooth survival. 10

Antibacterial (Basic pH) MTA has a basic pH which gradually increases from initial mixing to reach a pH of 12.5 after four hours. 11 This high pH is responsible for the antibacterial effects of MTA. This material has been shown to be effective against S. mutans, L. rhamnosus, L. paracasei, and P. gingivalius—all common microbes present in dental caries. 3 These properties are advantageous for a material used in vital pulp therapy as one may expect microbes to remain in dentin tubules despite conscious efforts to completely remove infected dentin.

Disadvantages Long Setting Time MTA sets in approximately two hours and 45 minutes. When the material is initially placed, its retention is purely mechanical. 1 Over time, however, a chemical bond forms with dentin. During this setting time, the material requires moisture, which can be problematic for many dental materials. Other potential problems for MTA include the following: 1) material can wash out due to prepping, and 2) MTA cannot be etched, rinsed, or bonded to. This means that most MTA must be temporized while it sets, or else the material must be covered with a moisture-tolerant product such as a glass ionomer cement before a moisture-intolerant substance such as composite resin can be used. Experience shows that pulpal therapy is more successful when a final restoration is placed at the time of treatment regardless of material placed.

Difficult Handling Like using any material in dentistry, handling MTA involves a learning curve. 5 The learning experience is further complicated by the fact that MTA handles differently based on the amount of hydration involved in the mixing of the material. This author’s opinion is that the material handles similarly to sand. Wet MTA will handle like sand that has just been washed by a wave of the ocean, while dry MTA will resemble a sand castle that has been baked by exposure to a warm day in the sun. Achieving the proper mixture is a key factor in ensuring the proper handling qualities calculated to match the clinical situation. The hydration properties can be advantageous when placing the material as an orthograde, root-end filling material in permanent teeth. If the material is too dry, it can be rehydrated to allow for apical advancement. 12

Cost The cost of MTA can be a concern as practitioners look to keep office overhead low. The cost per use of material varies depending on the manufacturer and the type of packaging used. MTA requires moisture to set, and although uni-dose MTA products prevent the material from being exposed to humidity in the air, a single dose may contain more material than needed to treat a tooth, thus increasing waste. On the other hand, MTA that is stored in a multi-dose package, needs to be sealed from humidity to prevent the material from setting prior to use, another risk potentially leading to increased overhead costs.


Sh i f t mag az in e / Sp rin g 201 7


vs FOR


MTA AS A BASE Fig. 1. A deep carious lesion (greater than two-thirds into dentin, upper left) was treated with an indirect pulp cap (base). Rubber dam isolation was utilized in case a pulp exposure occurred.  After caries removal (upper right), 1.5 mm of SmartMTA was placed and allowed to set.  Final restoration was completed with a Tesera resin inlay (bottom right).


s. RMO Pulp Capping

MTA AS A DIRECT PULP CAP Fig. 2. A deep carious lesion was diagnosed with reversible pulpitis on a permanent molar treated with complete caries removal (upper left). The pulp was exposed and treated with sodium hypochlorite, and a layer of MTA was placed (upper right).  The tooth was temporized (lower left) and restored with a resin composite (Premise) at a later date.  At two-year recall, the tooth remains asymptomatic and shows no signs of apical pathology (lower right).


MTA AS A PULPOTOMY AGENT Fig. 3. MTA has been shown to have equivocal results as FC when used as a pulpotomy agent in primary teeth. Tooth #K and #L had deep carious lesions (upper left) and caries removal was completed for diagnosis (upper right).  Tooth #K was hyperemic and extracted; tooth #L was treated with an MTA pulpotomy.  After disinfection with sodium hypochlorite, MTA was adapted to the pulp covering the entire pulpal floor (lower left).  The tooth was then restored with a full-coverage restoration (lower right).

www. sp r i g u m / S pr i n g 2 01 7



Staining The staining experienced in the use of MTA is attributed to bismuth oxide (an added radiopaquing agent) and sodium hypochlorite. 13 Sodium hypochlorite is a commonly used endodontic irrigant which dissolves organic matter, exhibits bactericidal and lubricating qualities, and is readily available. The staining can be reversed by bleaching after therapy is completed. However, this practice may be problematic in cases where there is no room in the pulp chamber. Newer formulations of calcium silicate products manifest less discoloration when they encounter sodium hypochlorite. 13

Conclusion The field of pediatric dentistry continues to engage in an ongoing debate regarding the use of formocresol in primary tooth pulpotomies. Researchers debate formocresol’s toxicity and potential carcinogenicity, and the value of using MTA as a viable alternative. 14,15 In scientific reviews, MTA has shown equivocal results compared to formocresol when used as a pulpotomy agent. 16,17 The material is a viable replacement for the formocresol pulpotomy. MTA is also superior to calcium hydroxide in direct pulp caps on permanent teeth, and can be used to replace calcium hydroxide in the Cvek (partial) pulpotomy. 18,5 The versatility of the material in treating clinical scenarios of dental caries or trauma suggests that the material should hold an important place on the shelf of every pediatric dental office. The use of MTA in the treatment of primary and permanent teeth is soundly supported by the scientific literature. 5




Setting Time Staining Cost Unit dose (contamination, setting if product is open) Handling (easy mix, place with familiar instrument [amalgam carrier]) Dentin bridging (faster than CaOH, no bridge forms with Formo) Vital tissue is maintained (Formo mumi es tissue) Non-toxic/Biocompatible Antibacterial (pH) Bacterial entombment Diverse use in permanent and primary teeth (replaces multiple materials including CaOH and Formo)

Sh i f t mag az in e / Sp rin g 201 7


Torabinejad M, Hong C, McDonald F. Physical and Chemical Properties of a New Root-End Filling Material. J Endod. 1995;21(7):349–353.


Sakar N, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I. Physiochemical Basis of the Biologic Properties of Mineral Trioxide Aggregate. J Endod. 2005;31(2):97–100.


Kim R, Kim M, Lee K, Lee D, Shin J. An in vitro evaluation of the antibacterial properties of three mineral trioxide aggregate (MTA) against five oral bacteria. Arc Oral Bio. 2015;60:1479–1502.


Yoo J, Chang S, Oh S, et al. Bacterial entombment by intratubular mineralization following orthograde mineral trioxide aggregate obturation: a scanning electron microscopy study. Int Jour Oral Sci. 2014(6):227–232.


Parirokh M, Torabinejad M. Mineral Trioxide Aggregtate: A Comprehnsive Literature Review — Part III: Clinical Applications, Drawbacks, and Mechnaism of Action. J Endod. 2010;36(3):400–413.


American Academy of Pediatric Dentistry. Guideline on Pulp Therapy for Primary and Immature Permanent Teeth. Pediatr Dent. 2014;36.


Ford T, Torabinejad M, Abedi H, Bakland L, Kariyawasam S. Using minteral trioxide aggregate as a pulp-capping material. J Am Dent Assoc. 1996;127(10):1491–1494.


De Rossi A, Bezerra Silva L, Gaton-Hernandez P, et al. Comparison of Pulpal Responses to Pulpotomy and Pulp Capping with Biodentine and Mineral Trioxide Aggregate in Dogs. J Endod. 2014;40:1362–1369.


Nowicka A, Lipski M, Parafiniuk M, et al. Response of Human Dental Pulp Capped with Biodentine and Mineral Trioxide Aggregate. J Endod. 2013;39(743–747).


Tahan E, Celik D, Er K, Tasdemir T. Effect of Unintentionally Extruded Mineral Trioxide Aggregate in Treatment of Tooth with Periradicular Lesion: A Case Report. J Endod. 2010;36(4):760–763.


Torabinejad M. Clinical Applications of Mineral Trioxide Aggregate. J Endod. 1999;25(3):197–205.


Al-Kahtani A, Shostad S, Scifferle R, Bhambhani S. In-Vitro Evaluation of Microleakage of an Orthograde Apical Plug of Mineral Trioxide Aggregate in Permanent Teeth with Simulated Immature Apices. J Endod. 2005;31(2):117–119.


Camilleri J. Staining Potential of Neo MTA Plus, MTA, Plus, and Biodentine Used for Pulpotomy Procedures. J Endod. 2015;41(7):1139–1145.


Casas M, Kenny D, Judd P, Johnston D. Do we still need formocresol in pediatric dentistry? J Can Dent Assoc. 2005;71(10):749–751.


Lewis B. The obsolescence of formocresol. J Calif Dent Assoc. 2010;38(2):102–107.


Stringhini E, Vitcel M, Oliveira L. Evidence of pulpotmy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol. Eur Arch paediatr Dent. 2015;16:303–312.


Coll J, Seale S, Vargas K, Marghalani A, Al Shamali S, Graham L. Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-analysis. Pediatr Dent. 2017;39(1):16–27.


Marques M, Wesselink P, Shemesh H. Outcome of Direct Pulp Capping with Mineral Trioxide Aggregate: A Prospective Study. J Endod. 2015;41(7):1023–1031.

Do you MTA? If not, this might just be the perfect time to give it a try.

www. sp r i g u m / S pr i n g 2 01 7


A BRAND New Beginning How Branding Affects Trendsetting in the Field of Pediatric Dentistry By Alan Siegel


S h i f t mag az in e / Sp rin g 201 7

www. sp r ig u m / S pr i n g 2 01 7



Sh i f t m ag az in e / Sp rin g 201 7


Alan helped define some of the most iconic brands of our time, including the NBA, Xerox, American Express, Caterpillar, Girl Scouts, Aetna, Pfizer, MasterCard, National Geographic and many others. Always an innovator, Alan developed the concept of Brand Voice™ and was one of the first in the industry to use the internet as a tool for brand communication.

Alan Siegel Branding Legend


ver the past few years, EZPEDO has grown from a relatively new, niche provider of pediatric dental products to a dominant player in the market, one competitors are seeking to imitate. Within this context, EZPEDO approached us at Sieglevision to help them enhance their role as an industry leader and innovator. In order to own this position in a largely stagnant part of the dental industry, EZPEDO is evolving their brand to better represent their success and ambitions, and to take ownership of who they are as a company and who they strive to become. The dental industry as a whole is also facing a critical crossroads. Consumers are more health conscious than ever, and their expectations of healthcare are increasingly being influenced by technology. This means that traditional practices and antiquated techniques are not going to cut it. It is up to companies like EZPEDO to be the pioneers in the field of oral health technology and influence industry-wide change in order to meet the heightened expectations of today’s patients.

Faced with these challenges, EZPEDO is refocusing its image and rebranding its identity. Let me provide some background.

Branding—Who Are You, and Why Should I Care? When people hear the word “brand” they often think of logos, advertisements, or slogans. While these are visible components of a brand, the essence of your company’s brand is unseen and rests in your identity—who are you, how are you different, and why should I care? In other words, what makes your company unique, and why are you valuable to customers and society? Your brand includes everything from visual identity to the values that permeate your corporate culture. Strong, relevant brands engender customer loyalty, clarify an organization’s purpose, boost business value, help distinguish a company from competitors, and serve as the most effective antidote to commoditization. Today’s most powerful and popular brands have clear identities: Apple, Google, Starbucks. These companies know who they are and what they stand for, and their identities drive everything they do and say. When a company has a strong brand identity, customers know what to expect from it and trust the company to deliver reliable products and services. This trust factor is increasingly important as consumer demographics shift and millennials take over as the dominant customer base.

www. sp r ig u m / S pr i n g 2017


Creating a Lasting Brand in a Rapidly Changing Environment We are now dealing with a consumer base that is much savvier and consequently more skeptical of brands and the messages received from them. I’m talking about millennials. Because of their access to vast amounts of information—ranging from a brand’s pricing to its product quality—millennials expect their brands of choice to be authentic, personalized, adaptive and fresh. Millennials seek longterm relationships with brands and want their brands to create customized experiences for them. To be successful in this evolving landscape, emerging brands must be authentic and innovative in order to connect with consumers and make them feel valued. This is especially important in the field of healthcare, where patients are better informed than ever before.

The ‘Healthification’ of Everything The healthcare landscape is undergoing an exciting transformation. Empowered by technology, today’s patients are more informed and more demanding of their healthcare providers. They increasingly shop around for providers, research treatments, and take a more active role in managing their healthcare. Millennials show a greater interest in health and wellbeing as a whole; and as a result, healthcare is making its way into seemingly unrelated industries. Take for example, the fashion industry with the Apple Watch Hermès and even the automobile industry with the Nissan self-driving cars, to name a few. Health is everywhere, and the increasingly competitive markets mean that healthcare providers, suppliers, and equipment manufacturers have to be more aggressive in how they articulate their value and differentiate their brands. The deployment of technology has created a more dynamic market. Successful emerging healthcare companies are positioning themselves as customer-centric brands based on value and innovation rather than traditional clinical brands based on service offerings. Technology has dramatically changed the way patients interface with their healthcare providers.

Healthcare Got a Makeover … and Dentistry Should Too The demands of today’s patient/consumer have been profoundly shaped by technology. In addition to using technology to investigate healthcare options, people are also increasingly expecting from their healthcare providers the same simple and seamless experience characteristic of the consumer technology companies they love. This is why the hottest healthcare startups look and feel more like Apple than Anthem, with sleek visuals, edgy personalities, and a heavy focus on customer experience. In fact, I saw a survey recently that found consumers would rather have Amazon or Google manage their healthcare than healthcare companies—now that says something! Unfortunately, the dental industry has been slow to adapt to these trends, and consequently patients seldom associate dentistry with innovation. A longtime friend of mine, renowned cosmetic dentist Larry Rosenthal, speaks to this perception in his eye-opening (not to mention mouth-opening) book Open Wide(r). In it, he admits, “most baby boomers in particular can’t shake the image of the dentist as a little more than a barber with drills, forceps and needles.” Doctor Larry makes a compelling argument for prioritizing your child’s oral health. He points out that cavities, crooked teeth, bad bites and jaw issues are often preventable when we are children— before our adult teeth come in. Proactive means preventive, and preventive means a happy and healthy child. Maybe what parents need today is an app to remind them of that. The problem is, most patients still think of their dental experiences as unpleasant, painful, and expensive. Although dentists know that good oral health is critical to a person’s overall wellness—not to mention their self-esteem—the public will continue to perceive dentistry as old-fashioned and “uncool”


Sh i f t mag az in e / Sp rin g 201 7

unless dental companies align their offerings, culture, and brand with 21st-century consumer expectations. There is hope, however. Many newer dental companies have made significant strides. Previously invasive procedures are now quick, painless, and affordable. New models of care delivery, like mobile dental practice Studio Dental, have emerged to cater to the lifestyles of the new consumer. There’s a greater focus on dental technology that’s simple, healthier, and more natural than the legacy products of the past. All of these trends, while still in their infancy, are enormously positive for the oral-health industry.

EZPEDO as a Blueprint for Innovation For many upstart oral-health product companies such as EZPEDO, innovation is in their DNA. They’ve seen the shortcomings of legacy products and are designing better solutions for 21st-century patients and professionals. EZPEDO, for example, is challenging the dominance of traditional stainless steel crowns in the pediatric dental market. Why would any parent want to put metal in their kid’s mouth if a more natural, better-looking alternative was available? EZPEDO created that alternative, using a biocompatible material called Zirconia and a patented design that ensures adhesion and comfort. In order to reflect this spirit of disruption and innovation, EZPEDO needed to clarify how it is different in an increasingly commoditized niche. Rather than settle for the brand of a highend dental products company, EZPEDO is repositioning itself as an oral health technology company that’s fighting to bring to pediatric dentistry the innovation people demand and deserve— because the next generation deserves next-generation care. This orientation will help establish EZPEDO as a visionary within the pediatric dental products arena and compel it to further expand its offerings to reinforce its position as a technology innovator. In making this shift, EZPEDO will also be adopting a bolder, edgier, more aggressive personality that will elevate how it communicates with parents and customers, verbally and visually. This shift will help differentiate the company from its peers, many of which go to market with a safe clinical personality, but one that ultimately doesn’t align with the expectations of young parents and professionals. This point of view and attitude will also help EZPEDO bill itself as a thought leader in the industry. The company’s magazine and hands-on training programs are already great platforms for sharing knowledge and connecting with professionals. The new face of EZPEDO—Sprig Oral Health Technologies—will help broaden the scope and reach of these initiatives, providing relevant and inspiring information to pediatric dentists who share in the belief that pediatric dentistry can be innovative, relevant, and exciting.

Alan Siegel is one of the bestknown figures in the branding industry and a longtime advocate of clarity and simplicity in business. Alan is also the founder and chairman emeritus of global branding agency Siegel+Gale, one of the most respected branding firms in the world.

Siegelvision’s Philosophy “In a world plagued by complexity, our work is governed by a passion for clarity.”

www. sp r ig u m / S pr i n g 2 01 7


For young, forward-looking companies like EZPEDO, there is little that is more important than building your brand. Your brand helps build awareness during critical growth stages. It defines why you’re valuable to customers and explains why people should choose you over competitors. It helps create a consistent and memorable image of your company in people’s minds. It builds trust and gives your company a mission and voice that can energize stakeholders.

What Dental Practitioners Can Learn From EZPEDO’s Success In recent years, health and fitness companies have broken the mold in how they go to market, placing a greater emphasis on technological innovation and avant-garde visual identities. It’s time that the dental industry follows suit. We must awaken dentistry from its lethargy and recast the industry as innovative, cool and accessible. Companies like EZPEDO are leading the charge and are quickly becoming the exemplars of what dentistry in the 21st century should look like and stand for. Dental practitioners can learn from this example. Just because dentistry has looked and felt the same for a long time, doesn’t mean it has to remain that way in perpetuity. The practices that will succeed in the long run won’t necessarily be the biggest. They’ll be the ones that best align their values with the values of today’s patients. This means becoming more technologically driven—offering online booking, tablets in the waiting rooms, and digital patient education solutions. It means embracing a less clinical, more vibrant experience—more relevant waiting room reading material, more contemporary furniture, younger staff. It means investing in your brand and taking control of how people view your practice. Don’t settle for being the local dentist. Establish yourself as the only dentist around that actually understands the values and aspirations of your patients. Aligning your brand with today’s patients will show people that dentistry can be different and, in the process, create evangelists for your practice.

Continuing a Trendsetting Tradition as Sprig Oral Health Technologies EZPEDO’s new brand identity as Sprig Oral Health Technologies will have a profound impact on how the company views itself and on how the industry views it. Evolving their brand will help the company lead the way in redefining how parents, patients, and professionals approach pediatric dentistry. We at Sieglevision have led EZPEDO through a revisioning and restrategizing process. As a result, they are poised to cross new thresholds, prepared to lay the foundation for future product innovations, and primed to further establish their identity as Sprig Oral Health Technologies—the new innovative, trendsetting leader in oral health technology.



Sh i f t mag az in e / Sp rin g 201 7






WWW.SPRIGUSA.COM www. sp r ig u m / S pr i n g 2 01 7


A LOOK BEHIND THE SCENE True leaders create their own content and that’s exactly what we do at Sprig. So remember, the beautiful pictures of smiling children in our ads are not stock photos, they’re all special because they’re all our patients.


Sh i f t mag az in e / Sp rin g 201 7


www. sp r i g u m / S pr i n g 2 01 7


THESE PAGES: A skilled dental technician from Argentina donates his time to work alongside our dental team in providing dentures for local residents near Rurrenabaque.


Sh i f t mag az in e / Sp rin g 201 7

UNTO THE LEAST OF THESE Taking Time to Meet the Dental Needs of the Remote Jungle Region of Rurrenabaque, Bolivia by Patricia Rivas, DDS | Gabriella Garcia, DDS | Jeffrey P. Fisher, DDS PHOTOGRAPHY BY R.D. GALLANT

Read about the experiences of three dentists who had the extraordinary opportunity to serve at an orphanage in an under-served area of the South American country of Bolivia.

www. sp r i g u m / S pr i n g 2 01 7


ABOVE: Dr. Jeffrey Fisher spends time with Rodrigo and Samir, two brothers who received a compete oral diagnosis and rehabilitation (including Zirconia crowns) by our dental team in a local hospitalĘźs operating room. BELOW: A high school student from Weimar Academy helps to teach local children how to properly brush their teeth. OPPOSITE: Monica, a volunteer from Columbia with basic medical training, translates for one of the many oral

health care classes put on for the local indigenous communities surrounding Familia

Feliz. For some, this was the ďŹ rst time to ever use a tooth brush.


Sh i f t m ag az in e / Sp rin g 201 7

www. sp r i g u m / S pr i n g 2 01 7



ith over 7 billion people on this planet, how can I make a difference in this world? Many of us contemplate this question every day as we serve people in our own little corner of this beautiful globe we call home. As dentists, we make our living helping others. Whether through doing a prophy, a pulp and crown, or even an extraction and space maintainer, our professional skills do more than just provide for our families. They make an enormous difference in the lives of millions of children and parents in our communities.

But every once in a while, I feel a call to do more. We in North America take so many things for granted. It almost seems like there is a pediatric dental office on every corner. While there are places with limited access to dental care here at home, many countries of our world incredibly lack even the most basic dental supplies, things like tooth brushes or tooth paste. Over the last few years, I have enjoyed the awesome privilege of traveling with my wife and two children to different countries around the world to serve others.


Sh i f t mag az in e / Sp rin g 201 7

These short trips have made a profound impact on my family. While we go to make a difference in the lives of others, we often experience an even more powerful change in our own lives—because it is truly through service that we reach our highest calling. This year our destination was a rural community in a remote jungle region of Bolivia—the town of Rurrenabaque. A short plane ride from the capital of La Paz, this community tucked away in the jungle is home to a local orphanage called Familia Feliz. Here our group of over 40 (made up of high school students, medical doctors, dentists, and other volunteers) would spend the next 14 days. Housing 60 plus children—many surviving horrible stories of physical and emotional abuse—Familia Feliz is a safe haven for children who are starving for love and are longing for a place where they can feel safe and truly belong. During the trip, our dental volunteers served over 900 people from surrounding villages, including soldiers from two local bases, as well as the many children of Familia Feliz. Although we made a dent in meeting many of the local people’s dental needs, so much work still remains to be done. While our trip to Bolivia is over, our mission has just begun. And it is that mission that inspires us to keep looking for the next place to serve.—Jeffrey P. Fisher, DDS

THESE PAGES: ItĘźs a great feeling when you can save teeth instead of just extracting them. Dr. Fisher shows a little girl what her new tooth will look like just before Dr. Rivas cements it into place. This was the ďŹ rst pediatric Zirconia crown to be placed in the country of Bolivia.

www. sp r i g u m / S pr i n g 2 01 7


THESE PAGES: Dr. Garcia adjusts a well-worn Tofemire matrix. The use of bleach for sterilization often creates rust on the instruments, making them hard to twist. OPPOSITE BELOW: Four young soldiers from the local army base wait on an old wooden bench for their turn to receive dental treatment. For many, this was the ďŹ rst time in their lives that they had seen a dentist.


Sh i f t mag az in e / Sp rin g 201 7


am currently a dentist at Sanatorio Adventista del Plata in Entre Rios, Argentina. Ever since I was a young girl in middle school, I have had a desire to serve others. I was assisted in realizing my dream 17 years ago when a group of American doctors donated a portable dental unit. Since then I have been serving six months a year as a volunteer dentist in various countries of South America, the last three years in Bolivia. I have to admit that this opportunity for service is what keeps me motivated when I am in my own office. By giving the best of myself, the profit I make at home helps to cover the expenses incurred during my volunteer trips. As I write this article I am in Rurrenabaque, Bolivia, where for two weeks we are providing free dental services to orphanage kids, members of the community, and soldiers on a nearby army base. Our services include doing procedures such as restorations, hygiene treatments, extractions, and making dentures. The needs here are great, and few dentists are willing to do this type of work. My goal is to devote myself full time to service in this area. I have two big dreams—one is to have a mobile dental unit complete with a dental laboratory. That way we can provide service in many different places, spending one or two weeks in each area and providing more complete dental care that would include offering free dentures to people with the greatest need. My second dream is to place implants for patients at cost or completely free to the ones that can’t afford to pay. To do this, I need to have the sponsorship of a dental implant company or a dentist who would donate a certain number of implants monthly or supply us with the implants at cost. I hope to offer implants to every person in need and not just to society’s privileged elite. I have been blessed to have the support of a colleague, a dental technician, who like me is a volunteer, willing to make dentures at no cost. Seeing the transformation in people’s lives when they receive dentures brings us the greatest satisfaction of anything we do here in Bolivia. Most people can’t afford to pay for dentures, but when we provide them free, what a joy to see them being able to chew correctly again. Their self-esteem increases, their faces look younger, and best of all, they start smiling again without any shame. My colleague and I are both willing to dedicate our talents entirely to this mission without a salary. Material resources are not the problem when God provides. The greater difficulty is finding the human resources to meet the challenging needs, and we are committed to serving in Bolivia. Sometimes we may think that it is only the patients who receive benefit from this type of service, but in reality, we are often the ones most blessed.—Gabriella Garcia, DDS

www. sp r i g u m / S pr i n g 2 01 7



uring my 13 years doing dentistry in the U.S., I have never experienced such joy and peace in my heart as I felt serving the orphans and needy communities in Bolivia. Maybe some of you who are reading this article were one of the generous dentists who donated or loaned instruments, materials, or equipment for our endeavor. You have no idea what a great blessing you brought to the people of Rurrenabaque and the orphans of Familia Feliz. Our international team included dental professionals from Bolivia, Argentina, the United States, Colombia, and Mexico. All came with the same goal—to serve. One of our objectives was to provide every single orphan with a dental screening, a prophylaxis, and a fluoride varnish. We were delighted that our hygienist and her team were booked to the max. Sometimes we simply alleviated someone’s pain, and that was as important as it was to place a composite that allowed a person to smile. Here in the U.S., I'm used to the formality of having parents or patients fill out a consent form before doing any work. In Bolivia, on the other hand, we faced the reality that some of the kids walked for hours just to have an extraction done; and sometimes the oldest relative with the patient was another kid just 9 years old. During our stay in Bolivia, we worked under two extremes of practice. Some days we worked in a modern mobile dental unit or operated in the OR of the local hospital using general anesthesia. Other days, we worked while patients lay down in primitive outdoor conditions and with rain pelting our backs. At such times, I couldn’t help reflecting on how, in the U.S., the front office and the back office are always complaining about the difficulty of controlling the AC thermostat. I am a different person after returning from our Bolivia trip, not only because I now realize the huge resource differential between the U.S. and Bolivia, but also because I have come to appreciate that sometimes we are so busy with our daily lives that we don't take time to look at a beautiful night sky, full of stars. We are so busy that we don’t stop to reflect on what really matters in life. When you aren’t distracted by material things, you start appreciating people and caring about issues that are truly important.—Patricia Rivas, DDS


Sh i f t mag az in e / Sp rin g 201 7

THESE PAGES: Dr. Patricia Rivas administers local anesthesia to a young girl preparing for an extraction. In an area of the world where dental services are not readily available, itʟs sad to see how simple occlusal cavities turn into multiple extractions on so many of these beautiful young people. OPPOSITE BELOW: A time exposure of the beautiful night sky silhouettes the trees above Familia Feliz—Rurrenabaque, Bolivia.

www. sp r i g u m / S pr i n g 2 01 7


OUR SURGICAL TEAM: The surgical team (from left to right) consisted of Gabriella Garcia (dentist), Patricia Rivas (pediatric dentist), Samuel Li (medical anesthesiologist), Jeffrey Fisher (dental anesthesiologist), Tiffany Fisher (student assistant), along with Samir and Rodrigo (dental patients).



Sh i f t mag az in e / Sp rin g 201 7


www. sp r i g u m / S pr i n g 2 01 7



My kind of place.



Sh i f t mag az in e / Sp rin g 201 7

www. sp r i g u m / S pr i n g 2 01 7


Shift magazine - spring 2017  
Shift magazine - spring 2017