Oral Health labs Spring 2014

oralhealth

w w w. o r a l h e a lt h g r o u p. c o m

LABS Digital Dentistry Let us Look

SPRING 2014

3M True Definition Scanner

Expand

3M, 3M ESPE, Incognito and Unitek are trademarks of 3M or 3M Deutschland GmbH. Used under license in Canada. ©2014, 3M. All rights reserved.

All other trademarks referenced are the service marks,trademarks or registered trademarks of their respective companies. 1401-00074 E

YourOpen Possibilities and Trusted Connections The 3MTM True Definition Scanner gives you unparalleled accuracy, flexibility and control. You choose how you want to practice digital dentistry.

Accuracy.

Flexiblity.

Control.

• Send scans to your existing lab.

• Share open STL files with any system that accepts this industry-standard file format.

• Expand your possibilities via Trusted Connections with leading chairside mills, digital implant workflows and orthodontic appliances.

To take the next step, visit 3M.ca/TrueDef or call 1-888-363-3685.

Open Connections

WORKS WITH ANY SYSTEM THAT ACCEPTS STL FILES

Trusted Connections

DENTAL LAB

CHAIRSIDE MILLS

IMPLANTS

ORTHODONTIC APPLIANCES

Now with a Trusted Connection to

contents

4 10 12 16

“The Times They Are A – Changin”

From Here To 2020: Where is Digital Technology Headed?

On the cover Raquel talks candidly on page 5 about her dental journey.

Challenge: Value

2014 Digital Dentistry Roundtable

A BUSINESS INFORMATION GROUP PUBLICATION ORAL HEALTH LABS IS A SUPPLEMENT TO ORAL HEALTH

EDITORIAL DIRECTOR

CIRCULATION

DENTAL GROUP ASSISTANT

Catherine Wilson (416) 510-6785 cwilson@oralhealthgroup.com

Cindi Holder (416) 442-5600, ext. 3544 cholder@bizinfogroup.ca

Kahaliah Richards (416) 510-6777 krichards@oralhealthgroup.com

EDITORIAL ASSISTANT

PRODUCTION MANAGER

ACCOUNT MANAGER

SENIOR PUBLISHER

Melissa Summerfield (416) 510-6781 msummerfield@oralhealth group.com

Jillian Cecchini (416) 442-5600, ext. 3207 jcecchini@oralhealthgroup.com

Karen Samuels (416) 510-5190 karens@bizinfogroup.ca

Tony Burgaretta (416) 510-6852 tburgaretta@oralhealthgroup.com

VICE PRESIDENT, CANADIAN PUBLISHING

ART DIRECTOR

DENTAL MARKETPLACE – CLASSIFIED

ASSOCIATE PUBLISHER

PRESIDENT, BUSINESS INFORMATION GROUP

Roy Gaiot

Karen Shaw (416) 510-6770 kshaw@oralhealthgroup.com

Hasina Ahmed (416) 510-6765 hahmed@oralhealthgroup.com

Alex Papanou

Bruce Creighton

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

3

editorial “THE TIMES THEY ARE A – CHANGIN” “The Times they are a-changin”, wrote, recorded and sang Bob Dylan back in 1963 and released in 1964. He reflected, no doubt, on his view of society at that time, which was evolving at a pace that was very visible to the songwriter and many other social commentators of the era. One of Dylan’s more famous songs, the portrayed emotion and visualization has been applicable to our environment for the past 50 years at varying levels of intensity. One could argue a similar parallel exists today, not only within the context of social and political change, but also within the working landscapes of industry and technology. If we observe a period of time that evolves within a given landscape faster than ‘the previous time frame’, then we could say “The Times they are a – changing”.

There are various and conflicting attitudes exhibited by individuals and companies throughout an accelerated evolution of change, whether they are peers or competitors. Sometimes obtaining a true and honest attitude toward these changes and the repercussions within the workplace by various individuals and companies can be challenging, especially when they may be placed within a different economic location inside the industrial kaleidoscope. People do not always have the same opinion of change – it may well depend on whether or not they have something to lose. The status quo is good for some people, albeit temporary. It can be a comfort zone, not requiring investment of thought, education, and finances into possible new technologies. It can also be bad for some people, in that it causes stagnation of thought, education and lack of competiveness within the marketplace. Let us not forget, not everyone has the resources or support mechanisms to facilitate change. There will always be a market (how large I am not sure), for the true artisan who ventures into the future, still embracing skills passed down through the generations (think of handmade artifacts).

Can we affect evolution of technology and its application? These new technologies are economically and environmentally-driven within the business landscape and they come and go as the technology evolves.

The digital revolution has definitely seen and witnessed monumental growth, both in the new technologies available and their applicable procedures. It should be said, “they come in various shapes, sizes and cost” and evolve so fast that sometimes a return on investment is not always possible. What was great yesterday may not be today. Yesterday’s cost for implementing the technology may not be the same as today’s cost (think of digital flat screen TV’s).

Importantly and often overlooked, digital technologies allow for elimination within the work environment of many procedures, which necessitate using undesirable chemicals and materials, or at best, lower their usage. Digitizing allows for a cleaner environment, which in turn encourages far less volume in the disposal of waste products (think of digital radiology, digital impressions and photographic camera film).

However, there is a downside for the “interested parties” who manufacture and sell materials related to the analogue techniques. They manufacture and sell less (Kodak).

I feel this simplified model has been, and is, being repeated throughout industry and especially within the Dental Profession. Let us not forget, “interested parties” include dental laboratories.

The interested parties need to diversify and modify their business operational plans in order to change. To not accept, or immerse at an acceptable pace into the changing landscape, will eventually leave them in a posi-

Trevor Laingchild’s sense of adventure has taken him on an international road in his profession. After formal Dental Education in London, England, he managed a Dental Laboratory in Germany and served as Chief Dental Technician for an American Hospital in Saudi

4

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

Arabia. Further experiences included, expanding his technical horizons whilst working in Norway, Scandinavia. He currently owns and operates dentalstudios in Burlington and in Yorkville, Toronto.

Trevor is an Accredited member and an Examiner within the American

P.6

Academy of Cosmetic Dentistry, in addition is a Certified LVI Master Aesthetic Technician. Trevor is very active lecturing and teaching whilst conducting numerous hands on courses in all aspects of restorative aesthetics, of which, he has had numerous articles published.

COVER SHOT Clinical Technical Photography

Dr. Jordan Soll Dentalstudios, Yorkville, Burlington Trevor Laingchild RDT A AACD

Primarily post-op photographs are taken in order to reflect back and educate us and others of clinical and technical cases completed. Kept portfolios, benefit from the addition of the post-op photograph, as it allows us to see the completed journey, especially when compared to the pre-op photographs.

Both clinically and technically, we can grow professionally when we maintain comprehensive photographic evidence of our treatment and restorative journey. Most importantly, it allows us to critique our journey, in order that we may improve our capabilities and our aesthetic goals.

Not to photograph, either with the pre-operative presentation of the patient or the subsequent treatment plan, leaves the clinician, laboratory technician and the patient visually challenged, missing one of the integral components of the communicative process. Any clinical aesthetic endeavor undertaken requires the use of quality photography and the appropriate investment into substantial photographic equipment. The single piece of equipment that has contributed to the public exposure, communication and education of quality dentistry has been the inclusion of digital cameras, in conjunction with comprehensive and consistent photographic protocols. Following these protocols will ensure and illustrate the individual’s professional growth and motivation for an improved standard of dental care.

In celebration of the upcoming World Cup of Soccer in Brazil, I felt it was appropriate to showcase and capture the emotion and the passion of a patient completing their clinical restorative journey, who just happens to be from Brazil.

Brazilian passion is world- renowned, whether it be with soccer or the arts, therefore it is appropriate that, while the soccer games are underway in Brazil, our cover shot patient Raquel will take us inside the passion felt, undergoing her dental treatment.

Raquel is a patient of Dr. Jordan Soll of Toronto. She underwent a maxillary arch reconstruction and a mandibular posterior reconstruction and on completion of treatment, I asked Raquel if she would give me her personal recollections and reflections of the treatment process, explaining and describing, in her own words the emotional journey that she had experienced. I feel it is important that we have empathy with understanding the emotions, which can be both positive and negative, that patients’ experience, when undergoing a comprehensive reconstructive treatment plan.

The following are the words of Raquel describing her emotional journey:

Pre-op Post-op

All my life I was conscious about my smile. After having going to so many dentists to clean, do root canals, crowns, etc. I got to a point where I thought I could no longer spend so much of my time and money, not having results I was happy with. That’s when cosmetic dentistry came to my mind. That’s when I decided to look for a professional who could help and guide me through the very important steps of my smile makeover!

At first, the experience was scary and overwhelming because I could not imagine the end results. And I knew once I started the process in which crowns were needed, I realized there was no going back! The “Big day” appointment came, and I remember feeling excited but very much frightened for what was ahead. All the consultation and prep appointments summed up what was about to happen. Later that day, when I had my temps placed in, it looked so much better, but I felt that did not suit me at all. I remember finding myself thinking and regretting all that I had done; wishing that I had never started it in the first place. It took a toll on me physically and mentally.

I remember feeling desperate and blaming myself for not being able to accept myself and that was a punishment! At that time, it was so important to have the support of my family and assurances that everything would turn out to be just fine, and that’s what I really wanted to believe.

Now, reflecting back on all the hardship I went through in making a smile makeover, I realize I could not avoid all those steps. It was not magic; therefore, I had to go through the process so I could have the smile I am happy with. If I had known the end process I wouldn’t even have second-guessed myself. I am just glad I was in great hands; professionals who had the confidence and expertise to bring me to the final results I can live with. Finally, I am very happy to feel myself again with one great difference – not feeling conscious because now I have a great smile!

By Raquel FSPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

5

P.4

tion whereby catching up will not be an option. Selective and financially responsible adaptions to these new technologies, I feel, is the way to go. Repercussions await purchasers of the new technologies that have not done their due diligence. Being the first on the block with the latest may not be the most prudent way either.

The Viking King of England, King Canute, once sat on his throne at the waters edge in front of the ocean in order to illustrate that he could not prevent the tide from rising, even though he was the King. None of us are kings and we also do not have that ability. However, I know of two living in Kingston, Ontario (is the name for the city a coincidence?) who have kindly contributed to this issue with their views on the digital landscape.

I think they would agree, all those years ago, that King Canute had it correct, even a King cannot prevent the tide from approaching and rising towards us. “The times they are a – changing.” We would all benefit from acknowledging this and having an open and educated mind, especially when business decisions, purchases and implementation of selective technologies need to be made.

As a dental laboratory owner, the big question is, will this technology affect my business?

Laboratory owners need to embrace these technologies and adapt to the changing environment of digital communication and fabrication. However, clinical digital fabricating techniques, which can circumvent the use of a dental laboratory in the fabrication of a restoration, will expand over time and develop to the point that the established dental laboratory will need to undertake a varied and also extremely focused business plan, in the ever competitive and global marketplace.

I would like to thank all the contributors in this issue, for their valuable insights and opinions. The conversation will continue.

Editor

Trevor Laingchild, RDT, AAACD

AMERICAN SOCIETY FOR DENTAL AESTHETICS

JOIN US Celebrating

the lifetime achievements of Dr. Irwin Smigel recognized by the Smithsonian Institute as the “Father of Aesthetic Dentistry.” Please join us for a reception at the Dr. Samuel D. Harris National Museum of Dentistry and a special tour of The Smile Experience.

for the 38th Annual ASDA International Aesthetic Conference October 22-25, 2014 The Four Seasons, Baltimore, MD fWorld-renoWned SpeakerS

Dr. Irwin Smigel

Dr. David Sarver

Dr. John Cranham

Dr. Roger Levin

Dr. Galip Gürel

f daily HandS-on WorkSHopS f Mentoring f luncH & learn

For information, please call

1-888-988-ASDA www.asdatoday.com

The Four Seasons Baltimore, MD

Dr. Christian Stappert

NEXT GENERATION

Multilink Automix ®

Adhesive Cementation System

“ Only the best will do

for my clients. For clinical reliability, I only recommend Multilink!”

– Barbara Warner Wojdan, CDT, AAACD

Contact your Ivoclar Vivadent representative today to see how Multilink Automix can help secure your laboratory‘s future.

Multilink Automix...Security you can rely on!

ivoclarvivadent.com Call us toll free at 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada. © 2014 Ivoclar Vivadent, Inc. Multilink and IPS e.max are registered trademarks of Ivoclar Vivadent.

proven

for

e.max

Clinically

IPS

More leading laboratories are recommending Multilink Automix for its strength, ease of use and proven reliability. Don‘t trust your hard work to anything less.

®

C-773-77-10-V1

ROBOTIC SCANNING THE ART OF THE ART OF FOR YOUR LAB INNOVATIVE DENTAL INNOVATIVE DENTAL TECHNOLOGY. TECHNOLOGY. The revolutionary 5-axis scanner with robot arm, innovative model positioning and open interface impresses with unbeatable precision, flexible handling, quick scanning times and an extremely broad application spectrum.

Enjoy every day. With Sirona.

Both individually and as an integrated system, the high-performance inLab components help you to exploit your skills to the full. Enjoy every day. With Sirona.

Both individually and as an integrated system, the high-performance inLab components help you to exploit your skills to the full. Enjoy every day. With Sirona.

FOR MORE INFORMATION PLEASE E-MAIL US AT: SALES.CANADA@SIRONA.COM FOR MORE INFORMATION PLEASE E-MAIL US AT: Maximum efficiency for all scanning tasks.

SALES.CANADA@SIRONA.COM

MANUAL & AUTOMATIC

peed crowns f HTC s inFire sintering o NEW: inutsepseed ns f crow 10 mHTC iinnFire sintering o NEW: inutes m in 10

e ftwar 4.2 so ases W S r all c inLab NEW: software fo ware n 2 so ft Desig SW 4. all cases b a L r in NEW: software fo n ig s e D

HIGHEST PRECISION

X5 perfect nningplatform for your designs and ic sca inEos oThe t : a W m E N ut al or a e production. ing manu rd tim s X5 o scann E o inNEreWc: in automatic al or manu rd time o c e r in ing of MC XL g and grind b a L in n open Scan data can be exported l STL minillithe NEW: s ofLmateria ding of format. e X in p C ainllLtayb M ling and gr il l m ia : r NEW s of mate e all typ

OPEN INTERFACE

See the robot arm in action now on video or at a dental trade show.

FOR MORE INFORMATION PLEASE E-MAIL US AT: SALES.CANADA@SIRONA.COM

sIrONA.COm sIrONA.COm

C-644-76-V0 C-644-76-V0

inEos X5 inLab inLab

THE ART OF THE ART OF INNOVATIVE DENTAL INNOVATIVE DENTAL TECHNOLOGY. TECHNOLOGY. Both individually and as an integrated system, the high-performance inLab components Both individually asskills an integrated the high-performance help you to exploitand your to the full.system, Enjoy every day. With Sirona. inLab components help you to exploit your skills to the full. Enjoy every day. With Sirona.

Both individually and as an integrated system, the high-performance inLab components FOR PLEASE E-MAIL US AT:every day. With Sirona. help MORE you toINFORMATION exploit your skills to the full. Enjoy FOR MORE INFORMATION PLEASE E-MAIL US AT: SALES.CANADA@SIRONA.COM SALES.CANADA@SIRONA.COM FOR MORE INFORMATION PLEASE E-MAIL US AT: SALES.CANADA@SIRONA.COM ns peed HTC s egdof crow e inFire sTinCtseprin ns w o r c : f WH inNFEiremsininutersing o inNE10W: utepseed ns f crow 10 mHinTC s in inFire sintering o NEW: inutes e ftwar m 4.2 so aw in 10 s e e r W s a S inLab e f4o.r2asllocft es NEW: soLfatwbaSrW s a c ig:n in are for all e DNeEsW w ftwar n soft 4.2 so ases Desig W S r all c inLab NEW: software fo n Desig

sIrONA.COm sIrONA.COm sIrONA.COm

X5 nning inEos tic sca NEW: orEaoustXo5ma scanning alin eomatic mNaEnWu: rdortim ut c aol a e e u r in ing man rd tim s X5 o scann o E inNEreWc: in automatic al or manu rd time o c e r in

ing of MC XL g and grind g of b a L in lin din W: MmCilXfLmgaatenrdiaglrin inNLEabpem n o li s il l y: ateria f aNllEtW ding o es oXfLm ainllLtaybpMC ling and grin l mil NEW: s of materia e p all ty

C-644-76-V0 C-644-76-V0 C-644-76-V0

inLab inLab inLab

From Here Where To is Dental 2020: Technology The dental technology profession as we know it has changed

Headed?

by Jason Robson, RDT

ver the past decade, there hasn’t been so much an evolution as a revolution, with technological breakthroughs delivering numerous new methods and systems to assist with the fabrication of oral restorations.

The digital era has transWhat it has also done is put the pressure on labs to keep formed the way dental restorations are designed and pace with the emerging technologies (which naturally come at handled. It has created an a cost) while simultaneously battling downward price pressures environment where consistent quality can be sparked by large offshore operations pursuing the same customer base. achieved while increasing productivity.

O

Jason Robson has been a Registered Dental Technologist (RDT) since 1994. He became President of the Association of Dental Technologists of Ontario (ADTO) in 2011. The ADTO is the member

10

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

association representing over 500 RDT’s in Ontario. The key responsibility is the members of the association and the promotion of the profession. Through the provision of continuing education

to support professional development and the advancement of standards, we assist our members in enhancing the quality of services provided to clients and the public.

These factors, combined with the fact that many newcomers to the dental profession are graduating with little knowledge of the role Registered Dental Technologists (RDT) play in oral healthcare, are causing many industry professionals to express uncertainty about the future.

So the question is: What will the industry look like by the end of the decade? Are we right to be concerned?

I believe we are at a crossroads, but to be fearful of what lies ahead is to look at a glass half full. What I see is a changing landscape, bringing with it exciting new opportunities. What we must be willing to do is adapt to the new reality, embrace what emerging technologies offer us, and look for ways to leverage our knowledge and experience to make us a stronger, better industry than ever before.

Let me digress briefly to make this point.

Xerox is a company whose name is synonymous with copiers. In the 1990s, it began to copiously bleed market share as Asian competitors made inroads with cheaper copiers and other hardware. The company was reeling with billions of dollars in debt, until a new CEO took over in the early 2000s and made a bold decision: Xerox would refocus itself on technical business solutions. It shocked its already worried investors with a $6.4 billion acquisition of a computer services company—the largest such purchase in its history—but the new CEO’s instinct was proven right. Xerox righted the ship, and today draws most of its revenue from services, not hardware.

The history of successful companies that have survived through generations reveal a similar thread: IBM, Apple, American Express, Nokia, Shell, Nintendo have all faced up to industry upheavals, reinvented themselves and become stronger in the process.

What lessons do their stories have for us? Here are a few: 1> Take stock of the situation. Ignoring the new reality will not change it. Instead, spend the time to evaluate the current situation—both the positives and the negatives—and understand how you can leverage both to your advantage.

2 > Play to your core strengths. What’s the one thing that a newcomer cannot bring to the table? Experience. It is important to understand that most new entrants to the industry are profitdriven manufacturers whose depth of knowledge is often limited to the products they produce. The kind of all-round knowledge that comes through hands-on experience and unique situations is something you need to promote.

3 > Educate your target audience. New dentists who have recently started practicing aren’t taught very much about the workings of a lab and the important role that RDTs play in their patient’s oral health care. We need to step up with campaigns to educate dentists that an RDT stands alongside them as a key component of the oral health care team, with the technologist able to communicate information instantly when required.

4 > Educate yourself. Constant innovation and change means it can be hard to keep track of the latest developments in the field.

Taking steps to seek out information on new materials and emerging technologies—and implementing them in your own lab processes where possible—gives you leverage over lab professionals who are standing still. There is a strong case for a higher level of education for RDTs as well, and there have already been early steps in this direction taken on both sides of the border.

5 > Get 2020 vision. Staying ahead of the curve means being willing to invest both money and time in the short-term with the aim of coming out in front in the longer term. It includes evaluating and purchasing new equipment, hiring and training staff with the right skill sets, building strategic alliances, and strengthening relationships with dental offices. Investing now and solidifying a reputation may seem expensive; but waiting it out could very well wind up being the more costly decision.

Which brings me back to my original question: What will the industry look like in 2020?

Having polled many members of the Association of Dental Technologists of Ontario through conversation and email (a rather unscientific poll, I will admit), I am heartened by the response. There is a cautious optimism that the changes necessitated by the new market realities will help us grow stronger.

Many RDTs also believe that the price pressures from offshore operations will ease up as large labs in North America invest in equipment and processes to make manufacturing costs competitive with those companies. That, combined with the already strong disincentive of high shipping costs and turnaround time for overseas operations, will help to level the playing field in the years to come.

The consensus appears to be that major labs who have the funds and willingness to invest in new technologies will grow stronger. The expectation however is that new networks and alliances will emerge—perhaps one large lab with many smaller satellite labs, or a franchise-style operation of several privately owned labs.

More private equity will become available as investors look to capitalize on a growing industry. Some predict larger dental offices will try and set up their own in-house labs—and fail.

One thing everyone is agreed upon: The relevance of the RDT is not going to shrink anytime soon; on the contrary, their wealth of knowledge means opportunities for well-trained, skilled dental technician professionals will remain healthy. Specialization and staying current with latest advances, they stress, is a key to success.

As for the current moment in time, the overarching feeling is that while there are challenges, it is these very challenges that will drive the profession to elevate our standards, embrace new technologies and earn a newfound respect for the important role that RDTs play in health care. L SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

11

Challenge:Value Pressed ceramic veneer restoration with IPS e.max Press Impulse

alue is key in imitating the natural tooth to achieve a lifelike result. In esthetic anterior restorations, the dental technician is ideally involved right from the beginning – even more so, if a diagnostic wax-up, or mock-up, is required to visualize the treatment outcome. However, some situations in everyday practice may make it impossible for the dental technician to be part of the treatment at an early stage and such a case is described in the report below.

V

Preoperative situation The female patient visited the practice for emergency treatment. In an accident, the incisal edges of the central incisors had broken off. Primary treatment consisted in covering the fractured teeth with a temporary. The esthetic appearance of the temporary restoration was of secondary importance at this stage (Fig. 1). After initial treatment, it was time to initiate the next stage: final treatment planning. A decision was taken to use two pressed ceramic veneers for the permanent restoration.

In the lab Being able to talk directly to the patient is an advantage to the dental technician when designing an esthetic restoration. This enables the technician to respond individually to the patient and to gain a better understanding of the patient’s desires and expectations. In this case, the patient told us that she had quite prominent incisors and the temMichael Beerli, MDT, studied dental technical in Scaffhausen, Switzerland (1986-1990). He is a qualified dental technician and skilled ceramist. He has wide experience in aesthetic restorations and proven

12

by Michael Beerli, MDT

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

poraries were not reflecting her natural smile. Unfortunately, pictures or models of her original oral situation were not available. She also informed us that the two anterior teeth slightly overlapped each other, possibly due to crowding in the upper anterior region and the difference in width of the incisors.

The initial situation on the model resembled the case of a minimally invasive veneer restoration; only the enamel surfaces were in need of replacement. In this case, adapting the shape and structure of the anterior teeth was not as much a challenge as recreating their shade and value. The patient presented very bright teeth with a great deal of depth. The teeth seemed to be shining from the inside because of their high opalescence.

Figure 2 shows that the patient’s tooth shade could not be determined with standard shade tabs such as the Chromascop or A-D shade guides; the natural teeth seemed to absorb the light, without appearing grey or dark in shade.

capacity to resolve complex and combined implant cases. From 1992-2006, he practiced in Mexico City. During his time in Mexico, he was a consultant for Ivoclar-Vivadent and participated as a member

on the Board of Directors for the “Mexico City Prosthodontic Association (APM)”. In 2006, he came to practice to the US and in Oct. 2013, he joined “Blue Crane Dental Lab” in Virginia Beach, VA.

The patient received two temporaries on her upper anterior incisors as an emergency measure.

Esthetic concerns were of secondary importance at this point.

Figure 2 Two veneers were planned for the final treatment. The patient exhibited a very bright tooth shade.

A standard shade guide did not allow the tooth shade, or value, to be determined accurately.

Figure 3 We normally use the Ultimate shade guide for shade selection in bleached teeth. In this case, tab no. 4 matched the value of the natural teeth perfectly.

Figure 4 Photo editing: Playing with the brightness values provides valuable information about the “inner life” of a tooth.

Figure 5 If a pressed veneer is held against a light source, its opalescent effects are clearly visible.

Figure 1

1

The Ultimate shade guide

2

With this situation in mind, I remembered a shade guide that we usually have lying way back in the “shade tab” drawer: the Ultimate shade guide.

Originally meant to reflect bleached teeth, the Ultimate shade guide consists of nine shade tabs. Although our patient never had her teeth bleached, tab no. 4 exactly showed the brightness and depth that matched her teeth (Fig. 3).

3

Shade selection with dental photography Digital photography and image editing has changed shade selection in recent years. Today I cannot imagine doing with- out these helpful tools. Adobe Photoshop and Google’s Picasa have become the standard software programs for image editing in our day-to-day work. While the pictures are taken with a fixed set of parameters, they are routinely processed, including white balance, exposure and more. By “playing” with the images, or with the value of the tooth, I can visualize various value zones and obtain an impression of the inside of the tooth, almost like “looking” into it. Picasa is a fast and easyto-use image editing software. Inside the menu, it contains a “shadow” slider, which increases contrast and lowers brightness. Figure 4 shows the image after editing. Compared to Figure 3, the effects, details, translucence as well as the light absorbing and reflecting zones are clearly visible.

4 5

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

13

Tips for dental photography >A lways determine the shade before preparing the teeth or set an appointment afterwards (to allow the teeth to rehydrate before shade taking). >T he shade tab (shade guide) has to be on the same facial plane with the tooth under inspection. >T ake the picture with a slight “nose tipped down” angle to obtain a clear picture of the tooth’s details. > Take pictures from various angles. > Avoid reflections. > Always use more than just one shade tab. >M ake sure the shade information showing on the shade tab is included in the picture.

6 7

Ingot selection Selecting an appropriate ingot is essential for a successful outcome when working with pressed ceramics. The new IPS e.max® Press Impulse range enables users to realize life-like results in a rational manner. These ingots are value-based rather than shade-based like conventional ingots. The Impulse range includes Opal ingots, which enable users to replace enamel without individual layering. This is particularly convenient in very thin veneers or in “extremely” white teeth, as in the case described here.

How can we imitate these white teeth with their expressive inherent shade characteristics? The Opal ingots were the answer to this question. Although these ingots are originally intended only for the replacement of enamel, they are ideally suited for situations like ours. The Opal 1 and Opal 2 ingot shades (IPS e.max Press Impulse) allow the press ceramic technique to be used even with a difficult initial situation (Fig. 5).

After we selected a matching shade tab, we encountered another issue: The shade tab consists of 3mm of incisal material over a layer of bright dentin. By contrast, the space available in the present situation would only allow for a veneer with a maximum thickness of 0.8mm. In view of the bright shade and limited space, reproducing the apparent effect of depth presented an additional challenge. We selected an Opal 2 ingot. As we had to extend the incisal edge a little bit and make sure that the incisal preparation line did not show through, we felt that this was a safe choice.

Fabricating the veneers The veneers were to be pressed in their full anatomical contour and then customized with the staining technique. The wax pattern was created in line with the envisaged restoration; some areas were slightly overcontoured (Figs 6 to 8).

Sprueing, investing and pressing were performed according to the manufacturer’s directions.

14 14

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

Models for creating the wax patterns for the two veneers.

Figures 6-8

8

Contouring, shading and glazing Since the ingot selected (IPS e.max Impulse Opal 2) is very translucent, the shade of the natural tooth abutment (die) was mimicked to achieve the desired shade in the final restorations (Fig. 9). Light-curing IPS Natural Die material is ideally suited for this purpose. This tooth-coloured composite is utilized to prepare a die, facilitating the work with HT or Value and Opal ingots. As the die mimics the shade of the natural abutment, it creates an ideal basis for reproducing the natural shade of the given oral situation. If I use LT or MO ingots (IPS e.max Press), I only use the Natural Die material if the shade of the preparation is either very light or very dark in relation to the desired tooth shade. Rubber wheels as well as green and diamond impregnated stones were employed for finishing the restorations (shape, morphology) and for creating the surface texture. Figure 10 shows the veneers with the Essence material (IPS e.max Ceram) applied onto them. The added shade tab indicates that we are very close to the desired final shade and we are also right on target to meet the most formidable challenge of this case: the value.

Before the veneers were tried in on the patient, her natural teeth (abutments) were wetted with fluid (Vaseline or

9

13

10

14

11 12

Figure 9 Pressed veneers. The translucent restorations were finished on model dies made of light-curing tooth-coloured die material.

Figure 10 Veneers with IPS e.max Ceram Essence materials applied onto them. The value was close to the desired final outcome.

Figure 11 Completed restorations. The surfaces of the adjacent teeth were very smooth and the veneers were finished accordingly.

Figure 12 To check the value, Figure 11 was processed with the software program and then compared with the reference shade tab.

try-in paste) – without fluid, the air between the restoration and the natural tooth structure would block the light and adversely affect the evaluation of the shade. Usually, I finalize the surface structure at the finishing stage, paying atten-

15

Once incorporated, the restorations met the expectations of the patient. The natural teeth had been successfully mimicked – the balancing act between value and depth proved to be successful.

Figure 13-15

tion to matching the smoothness levels to the natural teeth.

The glaze was applied in a thin layer and slightly “underfired”. Generally, I prefer a manual final polishing (Fig. 11).

Once polished, the veneers were checked for their accuracy of fit, shape and function on the model. When we assessed the shade – or value – of the veneers, we were left with a positive feeling (Fig. 12). We then sent the restorations to the dental practice.

Conclusion This case was challenging. The value in particular required a special approach. We had to recreate the apparent depth, or inherent interplay of shades, without dropping the value (Figs 13 to 15). I was looking forward to hearing back from the dental practice and was pleasantly surprised to learn that the veneers had been successfully incorporated. The IPS e.max Press Impulse Value ingots facilitated the esthetic design of the restorations due to their inherent fluorescence and opalescence. In sum, we now can use the press ceramic technique to achieve a successful outcome even in a challenging situation like this.

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

15

2014

Digital Dentistry Roundtable F

rom diagnostics to treatment planning, from documentation to advanced treatment modalities, digital technologies have transformed the dental landscape. Oral Health Labs set out to gain perspective on how the introduction of digital technologies have impacted the relationship between dentists and labs across Canada. The conversation will continue with input from dental manufacturers in the Fall issue of Oral Health Labs.

16

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

George Freedman DDS, FAACD, FACD, FIADFE Dr. George Freedman is a founder and past president, American Academy of Cosmetic Dentistry; co-founder, Canadian Academy for Esthetic Dentistry; and Diplomate, American Board of Aesthetic Dentistry. Author or co-author of 12 textbooks, including “Contemporary Esthetic Dentistry” (Elsevier), and more than 700 articles, he is a REALITY Team Member. An internationally recognized lecturer on esthetics, technology, and dental materials, he was awarded NYU College of Dentistry’s Irwin Smigel Prize in Aesthetic Dentistry. A McGill graduate, Dr. Freedman is a Regent and Fellow of the IADFE and maintains a private practice limited to Esthetic Dentistry in Toronto.

Rick King, RDT, has been with the Shaw Group since 1972. Following his graduation from George Brown College that year, Rick earned his RDT in 1973. During Rick’s tenure with Shaw, he has grown a 5-person facility, strictly doing dentures, into a 27-person full service lab dedicated to meeting all the requirements of all its’ valued clients. Mike Callaghan began his lab career when he joined the Shaw Group in 1987. An RDT since 1989, and a renowned implant specialist, Mike is a well-rounded technician who has worked in every department of the dental lab.

Edward Lowe, B.Sc., D.M.D., is a 1986 graduate of the University of British Columbia’s Faculty of Dentistry. He maintains a full time private practice devoted to comprehensive functional aesthetic and reconstructive dentistry in downtown Vancouver, BC. Dr. Lowe is an accredited member and accreditation examiner in the American Academy of Cosmetic Dentistry and holds fellowships in the American College of Dentists, International Academy of Dental Facial Esthetics, and International Congress of Oral Implantologists. He sits on the editorial advisory board of the Dental Chronicle, Journal of Implant and Advanced Clinical Dentistry and is the editor-in-chief of the AACD’s Journal of Cosmetic Dentistry. In addition, he is an opinion leader and consultant for the Dental Advisor. Dr. Lowe co-mentors the

TEST study club with Dr. John Nasedkin in Vancouver and is currently adjunct faculty at the University of British Columbia. He has published over 60 articles and lectures internationally on aesthetic, restorative, and implant dentistry.

Grant Maier BBA, RDT, CDT Laboratory Manager of Aurum Ceramic @ LVI (specializing in Neuromuscular Dentistry), and VP of Core3dcenters® USA (comprehensive dental restorative and implant superstructure manufacturing). Upon graduating from Schiller International University in 1995 with a Bachelor of Business Administration in International Business, he completed his apprenticeship in dental technology and achieved his RDT and CDT accreditation. At LVI, Grant has been directly involved with the Advanced Anterior (Core 2) and Comprehensive restorative (Core 5) programs since 1998, and the Full Mouth restorative program (Core 7) since 1999 (when it was founded). In June 2003 Aurum developed a truly unique dental laboratory, for which Grant moved from Aurum Ceramic/Classic’s head office to open Aurum Ceramic @ LVI – a laboratory that provides fixed restorative, all-ceramic restorative solutions, which caters primarily to the Full Mouth Graduate of LVI. Grant continues to oversee operations in Las Vegas as well as being involved with LVI’s restorative and implant programs.

Dr Les Rykiss Graduated in 1990 from the University of Manitoba and obtained a DMD degree. Since then he has been in private practice in Winnipeg, MB. He has a Fellowship in the International Academy for Dental – Facial Esthetics (FIADFE), and an Associate Fellowship in Laser Dentistry from the WCLI. He is also a graduate and Mentor at the Nash Institute for Dental Learning in Charlotte N. C. where he received his Cosmetic Dentistry training. He has taught restorative and pediatric dentistry for several years at the University of Manitoba as well. He is a member of the Manitoba Dental Association, Canadian Dental Association, Winnipeg Dental Society, the Canadian Academy for Esthetic Dentistry (CAED), The American Society for Dental Aesthetics (ASDA),and past president of the Alpha Omega Dental Fraternity. He has written several articles on cosmetic dentistry and hard and soft tissue laser use.

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

17

Q A

What is the most recent technology item you purchased and why? What will your next tech purchase be and why?

Mike Callaghan The most recent tech purchase is the

Roland DWX mill. Next purchase probably another scanner to expedite the design process.

George Freedman My most recent purchases have been diagnostic: digital caries mapping, oral cancer screening and digital wireless radiography. The ability to detect and assess oral problems early allows me to treat patients proactively, protecting their oral health and encouraging minimally invasive techniques.

My next tech purchase will be a more powerful, 10W diode laser that significantly expands my soft tissue treatment range and permits in-office laser bleaching.

Rick King Rowland DWX 50 mill to help control our cost and maintain integrity of product Edward Lowe The most recent technology I purchased was digital intra-oral xray sensors by Zuma Dental (Z-Ray) to replace the phosphor plate system I was using DenOptix (Gendex). The three main reasons why I replaced the system were: 1. I think the digital sensors represent the most state of the art 2. The processing time is immediate which is invaluable for chairside procedures like implant placement and endodontics 3. The current DenOptix scanner software is Windows XP which Microsoft will stop supporting in April 2014.

Althought I have a large wish list of technology to acquire, my next technology purchase will likely be a digital panoramic xray unit (possibly in combination with a Cone Beam

18

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

CT) to replace the current analog one using the phosphor plates as the DenOptix scanner will not be supported. It will give what I feel are the most superior images for dental diagnostic purposes which my patients deserve.

Grant Maier We’ve purchased a variety of different technologies over the past 6-12 months: SLA-digital printing technology, milling technology, measuring software, CAM (Computer-Assisted Manufacturing) software, CAD (Computer-Assisted Manufacturing) software. These purchases were made primarily to provide either a customer solution or management logistics solution. Our next investments will be for a variety of different applications, some of which will be production technologies, some design technology, along with further logistical and tracking technology.

Les Rykiss My most recent technology item purchased was a CEREC Omnicam. I believe that digital dentistry has evolved to the point that both labs and dentists need to embrace it and realize that it will become standard of care in the not too distant future. The accuracy of a digital impression is spectacular, eliminating impression material inaccuracy.

Unsure of my next technology purchase but upgrading my digital systems are always an option.

Q

A

How has the introduction of digital technology impacted your practice/lab? How has it impacted your team, patients, dentist clients?

Mike Callaghan Digital has actually made labour harder to organize, has changed how we organize the lab. I believe digital has made our product more predictable, but dependence on the machine has started to happen, causing techs to think quality is already built into the restoration, when we actually need to spend a little more time on the restoration.

George Freedman Digital technology has propelled dentistry into the 21st century. From diagnostics to treatment planning, from documentation to advanced restorative modalities, digital technologies have transformed the cliniSPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

19

A

cal practice. The dentist and dental team have a more complete database that creates greater confidence in developing patient-centered protocols. Patients can select more comprehensive and longer-lasting care. Dentist-lab communications have entered an unprecedented area of 3-dimensional data sharing and collaborative decision-making.

Edward Lowe Digital technology has impacted my practice greatly and I feel it is an ongoing process. Technology will always evolve and as it does, we must replace current tech with new tech. Yes it costs money, however I feel it is a perpetual investment we must make in order to ensure we are current with the standards expected of us as dental professionals. How has it impacted your team, patients, dentist clients? The team and patients both appreciate the upgrades in technology. For patients, the “wow” factor is there and although patients are appreciative of the dental services and team culture that we provide, it certainly adds to their perception and opinion of the practice when referral of a friend or relative comes to mind.

The team welcomes new technology as it adds an air of excitement and new possibilities for learning to the practice.

Rick King We have been involved since 1987 with the advent of Procera. Every year we push to increase the ratio of digital to analog. We were able to maintain our production when 25% of my workforce retired two years ago. Our clients and their patients enjoy more integrity in their marginal fit.

Grant Maier Considering monolithic fixed restorative materials first, most of these can only be produced through the use of digital technology, so as a laboratory you really had no choice – the market was demanding the move to that technology. At the same time, digital or CAD systems have enabled our

20

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

business to become more efficient by eliminating many of the laborious or non-value-add steps involved in producing a restoration. CAD technology has also enabled us to be more consistently productive by as much as 100-200% in certain applications, for example for designing abutments (versus the previous process of waxing, spruing, investing, casting, devesting, trimming). How has it impacted your team, patients, dentist clients? Technology and the implementation of technology, is dynamic — it is a continuous transition or evolution. Generally, most of our team embrace the technology providing they are well informed and educated about its purpose, how they can use it to our advantage, and how it can positively impact the business and all of those involved.

Les Rykiss Only for the better. Patients love to see what the newest technology is and how it works. My team has embraced our digital technologies and accept the challenge of learning newer and better ways of doing dentistry. As a dentist, it keeps dentistry fresh for me. As time moves on, I realize that with every aspect of technology that I incorporate, it becomes invaluable for me to perform dentistry properly.

Q Q A A

Les Rykiss I’ll use my CEREC as an example. The choices for

How do digital technologies affect clinical restorative options and material choices?

Mike Callaghan Clinically digital, if doctors embrace it, will allow for better impressions with intra oral impressions. However I do believe that chair side mills produce inferior products, with poor margins.

George Freedman Digital technologies compile and organize vast volumes of seemingly unrelated data that enhance critical thinking and analysis. They improve and expand clinical restorative options while focusing attention on the most appropriate materials for a specific situation.

Rick King Your type of mill (Zirc / wax / wet etc) pushes you

in one direction more than the other unless you are strong enough and have the foresight to do what is best for the patient.

Edward Lowe In practices with a scanner and milling unit, the option of same day restorations milled chairside are available. This means the material choices are limited to those that can be milled, stained or polished, and delivered the same day. Extending the procedure to add a restoration delivery appointment increases the material choices available whether you are fabricating the restoration in-office or sending it out to a dental lab.

Grant Maier Currently, the biggest factor determining

material selection is value for price. That being said, many or most of the popular monolithic restorative choices are also illustrating superior clinical acceptance, both in research and in practice. The modern, monolithic materials are being designed with esthetics in mind, which is more attractive for the patient and easier for the dentist to present; but these materials are also being designed with better clinical science and with health in mind. And in today’s world, patients are more dental savvy and have a higher dental health IQ than ever before, so they’ll be driving product development indirectly, as we move forward.

CEREC in my office are limitless. If I mill the crown in office, it becomes a “crown in a single appointment”. eMax, Zirconium, Lava Ultimate, and Enamic are my choices. All are ceramic or ceramic composite blend. If I send my digital impression to an external lab, then I can also include metal, or metal ceramic choices. All of my in house choices are far better than the traditional PFM crowns in terms of flexural strength.

Have digital technologies changed communication modalities between practices and laboratories?

Mike Callaghan In my opinion digital dentistry has not improved the communication very much. Doctor’s have not embraced what is available to them so we do not communicate in a better way.

George Freedman Digital scan impressions of abutments and surrounding tissues are far more accurate than indirect polymerizing transfer materials. The same goes for bite registrations. Digital articulators leave the manual ones of the past century in the dust. Electronic shade scanning cannot be discussed in the same breath as visual shade-guessing.

Digitized implant-positioning eliminates the risk of poor placement and help determine the optimal location for maximum bone support.

Grant Maier Yes!!! Information is being captured digitally on many fronts: CT/CAT scans, digital x-ray, intra-oral photography, extra-oral photography, bite management technologies, tissue sampling technologies, implant treatment planning, to name only a few. All this information is basically being communicated using one of two approaches: siloed/closed or open.

The major difference is that the siloed or closed systems are limited in their scope, while the open systems are able to host SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

21

Q A A a variety of different communication modalities on the cloud (such as what Brightsquid Dental Link® has done, for example). Another driving force behind how we communicate today, and certainly into the future (although statistics show that this may still be perceived as ‘underground’ or ‘not relevant’ by many in practice today) are the Patient Privacy Compliance Laws (such as HIPPA). Under these laws, every individual a touch point of communication around the handling of patient information is responsible for following HIPPA compliance.

This includes those in the practice, the lab and anyone else involved in a patient’s case.

Rick King IOS devices definitely allow for better communica-

tion and faster response time. We also notice clients want to talk to us in non-office hours when they are free more frequently. We also now know that a dentist with a digital scanning device can send his work anywhere he wants!

Edward Lowe I will go on record as saying they have. Digi-

tal cameras can take photos and movies which are then exchanged electronically between dentist and ceramist. The dentist now has the means to digitally scan a restoration and send the file to the ceramist for fabrication of restorations without having to take an impression and ship a model to the lab. The possibilities are endless and they all point to better communication, faster communication, and ultimately the patient benefits.

Les Rykiss I can now email my digital impression to any lab around the world and they can begin my case immediately.

When I send digital photos to a lab for shade matching, again it has an immediate impact. I can relay information (and have) to a lab with my patient in the chair using Skype or FaceTime as well. Digital technology allows for greater accuracy in communication between the dentist and the external lab.

What are the most significant challenges facing labs and dental technicians with respect to digital technologies in terms of training, investment, education?

Mike Callaghan Digital dentistry and training is a very long process. I don’t believe that we should use average people for this position, as knowledge is paramount to the success.

George Freedman The most significant challenge facing labs and dentists is the entry cost of new digital technologies. In many cases, neither can pass the cost to the patient without losing clientele. Amortization over 3-7 years may be a financing option. Digital technology training is typically comprehensive for technicians but very spotty at the clinical level. Mandatory (and preferably free) training should be available to all purchasers.

Rick King We need a digital dental technology adjunct to our existing curriculum at colleges. We also need better personal resources to help us as business owners to make better decisions about what types of digital equipment to purchase (mills / printers etc).

Edward Lowe I think that the most significant is the willingness and desire to welcome and adopt digital technologies. Labs and technicians must first accept that fact that change is not to be feared and take a leap of faith. Once the mind is set to change, the main challenges are the learning curve associated with training, return on the investment, and time invested in education.

Grant Maier a. CAD/CAM or just CAD? Over the past several years, some Individual labs felt the need to invest in CAM themselves as opposed to looking at outsourcing to a larger independent North American-based specialist firm as a solu-

22

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

tion. For many of those that did choose to invest, this was a mistake – it caused logistical and organizational challenges, not to mention a major financial investment in specific systems, which for many has yet to yield a return and/or profit. The independent specialist manufacturing firm will always be able to offer the full spectrum of alternative manufacturing systems, allowing the best choice for each individual restorative situation, while the required initial and on-going update investment is simply beyond the capability of most individual laboratories. b. Training, but more importantly EDUCATION, is always important and always has been, regardless of whether you’re doing something analog or digital. For the implementation of digital, like the implementation of a press furnace, this is a paradigm shift from the ‘traditional’, which requires proper education with training. While training might be considered more like paintby-numbers of specific tasks and steps, education provides knowledge and understanding, where the individual can assess, create, diffuse, and trouble-shoot around a particular solution.

Les Rykiss I believe that labs that embrace digital dentistry and incorporate them in the business will ultimately benefit from them down the road. Yes there is an immediate cost factor, as well as a learning curve to utilize the technology, but any good lab technician will be able to incorporate their knowledge and have a much easier time relating to how it is affected by the technology.

Q

What does the technology future hold for dental practices/labs?

clinical practice. This will offer more time for the technician to develop the artistic restorations that are so highly prized by patients and dentists, and greater chairside efficiency allowing dentists to enhance their productivity.

Edward Lowe I believe that the tech future for dental practices is great as long as the dentist is willing to research and commit to investing both time and money into new tech. You never really own technology...you cannot purchase it and expect it to be state-of-the-art forever. One is simply borrowing technology and when the lease payments are over, it is time to reinvest again! Whatever happened to Palm Pilot? Anyone own an iPhone 3? :-)

Grant Maier Both in the practice and the lab, technology implementation and the daily use of that technology is the norm going forward. As far as the direction of the industry goes, it will mainly go the way some other industries have, such as the eye-glass industry and hearing aid industry, for example. For the most part, there will be consolidation, by the smarter, major players, of both the dental practice business and the dental laboratory business – the way it’s begun to already develop now. The smaller, private companies, which exist or will exist will be those that are highly specialized, with strong strategic anchors and market differentiators.

Rick King Consistent and higher integrity restorations, more investment by labs and dentists, the advent of different products and materials. Eventually more control over labour costs and the need for fewer technicians in the levelling off of the playing field. RELATIONSHIPS between labs and their clients will be even more important!

Mike Callaghan Technology can improve how we oper-

Les Rykiss I’m not sure exactly. Ultimately, robotics in the

ate and communicate if we all embrace it.

dental practice, to a certain degree may become reality. Already milling machines are doing that in lab. Digital caries detection perfection for sure will be coming down the road.

Perfecting and further simplification of digital impression systems will be reality within a year or two.

George Freedman As indicated by the trends of the past decade, future digital technology is likely to take over much of the drudgery in both the dental laboratory and the

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

23

Dental Marketplace

Contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: kshaw@oralhealthgroup.com Toll free: CDA 1-800-268-7742 ext 6770 • Toll free: USA 1-800-387-0273 ext. 6770

Associateships BARRIE, ON Looking for an orthodontist in Barrie.

Busy neighborhood. Start date March 2014.

Please forward your résumé to dental_manager@ hotmail.com DOVE DENTAL CENTRES Full time associate needed for progressive, modern, multi-location group dental practice in London, Ontario and surrounding area. Interested candidates should forward resume and cover letter to: dovedental@ody.ca

CHATHAM-KENT, ON Looking for a talented associate to join our team, in the Chatham-Kent area of Southern Ontario. We are a patient focused practice with full dedication to the quality of patient care. Communication is key and that’s why we pride ourselves on the knowledge and skills of our longtime support staff.

If you are interested please forward resumes to Karen at elitedental@live.ca

VICTORIA, BC

ASSOCIATE OPPORTUNITY NORTHERN ONTARIO Looking for an associate to help with Manitoulin Island and/or Sudbury general practices. Future buy in/buy out available.

Email: weebit_17@yahoo.ca

BARRIE, ON

Established family practice looking for a highly motivated part-time dentist. Evenings and Saturdays are a must.

Please email resume to smile@barrieheightsfamilydentistry.com

KITSILANO, BC

Available immediately, part time associate in the heart of Kitsilano. Wages negotiable.

Please contact Leanna at 604 736-2505 or email appts@4thavenuedental.ca

WINNIPEG, MB

Oral & Maxillofacial Surgeon Looking for an associate to join busy practice. Please forward curriculum vitae to: drwalton@mts.net

Career Opportunity of a lifetime.

WHY? 1. Full time associate position 2. Immediate full patient load 3. One of BC’s highest grossing practices 4. Westshore Area of Victoria – BC’s fastest growing community 5. Healthy new patient load 6. Available immediately To replace previous associate leaving due to health. Experience required, and Cerec experience would be an asset.

Must possess strong patient interaction and treatment presentation skills.

Please call (250)474-5308 or email dawn@westshoredental.com

NOVA SCOTIA

Want to be an Associate and not work for an Owner Dentist? Immediate positions (FT/ PT) available in Halifax (newly renovated), West Hants (30 minutes from Halifax, NS) and New Minas (NS). Very active hygiene programs. All positions come with a scaled remuneration structure based on individual and/or clinic performance. Company provides a variety of free CE along with other special packages.

Contact info@finetouchatlantic.com or call (902) 835-4222 ext. 223.

24

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

WHITEHORSE, YUKON FULL TIME DENTIST REQUIRED AND/OR LOCUM

Come enjoy the beauty of the great north in the beautiful city of Whitehorse, Yukon. Have the best of both worlds. Hiking, fishing, biking, sking are all waiting for you to enjoy!! Busy 8 operatory practice looking for a full time general dentist.

Please fax resume to Pine Dental Clinic at 867-668-5121 or email us at pinedental@northwestel.net

ST. CATHARINES, ON

Immediate part time associate dentist wanted in St. Catharines for Tuesdays and Thursdays from 2pm to 7pm leading to all day Thursday, Candidate must reside in the Niagara Area, be people oriented and have strong clinical skills.

Interested candidates should forward resume and cover letter to: info@lakestreetdental.ca

ASSOCIATES FOR HAMILTON & WATERLOO, ON

Associates required, for TWO VERY busy and modern practices with VERY strong new patient flow.

E-mail: associatedentist@ymail.com Fax CV: 888-880-4024

ASSOCIATES WANTED – BC, AB, ON

Dental specialty office seeks associate orthodontist, oral surgeon and dentist in BC, Alberta and Ontario.

Please send resume in confidence smiledoctors1@hotmail.com

SARNIA, ON

Associates needed – starting May 2014.

Modern office, digital, new equipment.

High traffic location and proven marketing system provides excellent patient flow. Must be willing to work some evenings and weekend hours.

Reply to Oral Health Labs Box 31 – e-mail: kshaw@oralhealthgroup.com

RED DEER, AB

The patients of a very busy practice in Red Deer requires a full time, energetic and caring dentist to start immediately. The right associate will be the primary caregiver to a large patient base and will have the potential for above average earnings. The entrepreneurial dentist will have the opportunity to buy in after 6 months. The practice enjoys modern equipment, good parking and a friendly environment.

Please email carol@rddc.ca

LARGE GROUP PRACTICE IN NIAGARA FALLS, ON Invites you to consider this exciting career opportunity. We are interested in a full time associate, who is focused on a long term, exclusive involvement, with a transition to ownership, with our group. We have a long established history of exceptional remuneration.

Email resume to nmdental@outlook.com

PART TIME ASSOCIATE WANTED — ONTARIO

Busy Family practice located 45 min outside Toronto is looking for a part time associate. Minimum 2 years of Canadian experience is required. Must be a great team player with strong dental skills and good bedside manner. Some Sat and evenings required.

E-mail only ddsfordentaloffice@yahoo.com

FORT MCMURRAY, AB

Fort McMurray Dental Clinic is looking for an associate to join our practice for a part-time/full-time position, must have at least 1 year experience.

Please sent us your resume at # 3 101 Signal Road, Fort McMurray, AB T9H 4N6 or by email at auroradentaltw@gmail.com ASSOCIATE OPPORTUNITY – TILLSONBURG AND BRANTFORD, ON AREA

Full time and part time available. Busy and established offices. Modern, fully paperless/digital, new equipment and leading edge technologies (cerec, lasers, implants...). Potential for buyout or partnership.

Interested candidates please mail: dentalgroupswo@gmail.com

VANCOUVER ISLAND, BC We have 2 clinics one in Ladysmith and one in Courtenay both are located on Vancouver Island. We are seeking a full time associate for general dentistry. Busy clinics with opportunity for growth and investment opportunity in the future.

E-mail: orca.dental@shaw.ca Fax: 250-338-7130. Tel: 250-338-5011 office manager Nola.

GRANDE PRAIRIE, AB

Three full time associates needed for our well established family practices, with travel to our satellite clinic in High Prairie, AB. Present associates will be leaving end of July 2014. Very busy practice with above average remuneration.

Please email drroy04@telus.net if interested.

TORONTO — BAY & BLOOR Associate wanted 3 days per week for contemporary high tech office committed to excellence. Looking for a teamplayer, passionate about dentistry and great patient care. Extensive surgical and endo experience necessary. Minimum of 3-6 years experience required.

Please send resume to associate.search5@gmail.com

OTTAWA AREA SANDHU DENTAL GROUP Looking for 2 full time hard working, committed associates within driving distance from Ottawa.

Will be busy from Day 1.

Please e-mail your resume to: rsandhu@sandhudental.ca Visit our website www.sandhudental.ca

TORONTO, ON ASSOCIATE REQUIRED Associate for busy, modern practice, full time in Toronto. Complete range of services provided including orthodontics, periodontics, implants, laser dentistry, digital impressions, oral surgery and conscious sedation. An excellent opportunity for professional developments and higher than average remuneration.

Call:416-748-3353 or 1-866-866-8437.

MARKHAM, ON Associate position part-time is available in busy mall location. Will be busy from day one. Position best suited to Cantonese or Vietnamese speaking. Can begin immediately. Friendly and personable is preferable.

Please email to Oral Health Labs Box 26 e-mail: kshaw@oralhealthgroup.com

AIRDRIE AND EDMONTON, AB

Excellent Airdrie and Edmonton location in Alberta; FT Associate positions available with buy in option considered. Owners are team of excellent experienced clinicians who are fun to work and you can expect ample vacation and balance between family and work with above average income.

Please apply in confidence to doffice05@gmail.com

ABUNDANT OPPORTUNITIES IN THE SOUTH GENERAL PRACTITIONERS AND ALL DENTAL SPECIALTIES ABLE DENTAL GROUP Jump start your career with us...

Associate or Buy-In Opportunities for the Right Candidate Exciting career opportunities are awaiting you in sunny southern Alberta. We are looking for motivated individuals to join our team of dental professionals who use “big city technology”, yet serving the needs of our community and surrounding areas.

The Group has always been one step ahead of the rest to take advantage of new technology and “looking outside of the box” attitude and ideas. We share this enthusiasm with our Associates and Staff, and we pride our company’s success on teamwork and providing a team environment.

Please contact our office to arrange an on-site meeting and viewing.

Shari Mead, Office Manager 403-327-7227 shari@abledentalgroup.com

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

25

WHISTLER, BC

Come for the lifestyle. Come for the once in a lifetime opportunity!

Modern, well-established dental practice located in beautiful Whistler, BC is currently seeking a highly motivated associate, with a proven commitment to excellence, continuing education and customer service.

Our office offers a large variety of dental services to our patients including dental implants, endodontics, oral surgery, orthodontics, TMJ therapy, sleep and cosmetic dentistry.

This is an excellent opportunity for someone looking to build a long-term career in the Whistler area and be part of a growing practice.

Interested candidates please send cover letter and resume to janis@whistlerdental.com

SASKATOON, SK Associate required for modern, very busy practice with strong new patient flow.

Great opportunity in a University setting.

E-mail: associatedentist@ymail.com Fax CV: 888-880-4024.

Full time Dental Associate required for a large Dental Group Practice. We are located in Northern British Columbia, home of the 2015 Canada Winter Games (visit website) www.canadagames2015.ca We are the most comprehensive & modern dental group in Northern British Columbia. Onsite, Oral Surgeon, Periodontist, Orthodontists. Complete support team. Relaxed atmosphere where you can develop your skills and financial security.

We are looking for a candidate who would like to start a dental career with us. Future provides, associate position, practice ownership as well as future investment opportunities.

Position available immediately.

Contact: 250-960-3802 Email us: admin@lakewooddental.ca Visit us at www.lakewooddental.ca

ORTHODONTIST ASSOCIATE WANTED – BC, ON Associate orthodontist or dentist with orthodontic background wanted for busy specialty clinics in Vancouver, BC and Waterloo, ON. Please contact: Tel: 778-985-6507 e-mail: smiledoctors1@hotmail.com

CALGARY, AB

EDMONTON, AB

We are searching for a full time periodontist to join our Neuromuscular Practice in Calgary, Alberta.

This individual will be committed to work in collaboration with our restorative and hygiene teams to ensure patients are receiving optimal health and will assist in the process of helping these patients achieve their long term goals. We are looking for someone very dynamic and relationship driven that is excited to join a team committed to our organizational values of Joy, Growth and Health. Practice provides 100% referral acceptance and is located in affluent area of the city with no one else providing these services nearby.

Candidate must have a minimum of 3 years’ experience.

If you are interested please send resume and cover letter to lavonne.keal@sierracentre.com

A full time associate dentist required to take over an existing full patient load from the current associate who is leaving. This truly is a very unique opportunity for a new associate to be immediately busy from day one.

The office is bright, modern and very well equipped and is continually updating the core systems to better position the office for the future. If your primary focus is the needs and well being of the patients, and if you are willing and able to work with others in a larger group practice environment then this clinic is right for you. A positive attitude, a sense of humor and some flexibility in scheduling will lead to a very successful and rewarding position for the right individual.

Email: qdental@shaw.ca Email: bay1chelsea@gmail.com 780-965-3787.

FULL TIME PERIODONTIST REQUIRED

26

PRINCE GEORGE, BRITISH COLUMBIA LAKEWOOD DENTAL GROUP

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

VICTORIA, BC

Associate wanted 2 to 4 days per week at established and growing Royal Oak Clinic and/or brand new Westshore clinic with anticipated full time work available very soon due to high growth rates. 2 years plus experience preferable.

Call Dr David Johnson at 250-813-0849 or email Shane Johnson at Shane@ParkwayDentist.ca

OAKVILLE, ON Orthodontist position available at our clinic. Nine patients currently awaiting treatment.

Please contact us by phone: (905) 827-2066 or e-mail: brontecosmeticdentistry@cogeco.net

THUNDER BAY, ON

Associate position available in a busy modern family practice. Experience is an asset but new graduates are welcome.

Email resume to ashibonn@hotmail.com

CALGARY, AB

GENERAL DENTIST REQUIRED

Expanding dental practice seeking experienced General Dentist to join our team. We are looking for someone that is looking for a different opportunity. Someone committed to growth, to health and wants JOY in their life and to provide JOY to their patients. We are searching for relationship driven providers that are committed to helping patients achieve their long term goals. That are committed to excellence in their standard of care. If you are looking for something different please send resume and cover letter to lavonne.keal@sierracentre.com and let us know what it is your searching for and how you want to make a difference in the lives of the patients and team you serve.

OWEN SOUND, ON

Full time associateship available in beautiful Owen Sound. Great opportunity in this long established, busy family practice. Pleasant and well trained staff and large patient load guarantees above average earnings. All facets of dental care offered in new, modern office. With a husband and wife DDS team leaving practice two positions are available — be busy from day one. We are looking for DDS who is ethical, productive and pleasant. Must be willing to work some evening and weekend hours.

Reply to drtimpringle@bell.net

VERNON, BC

Cornerstone Dental Group is seeking a full time associate to take over an existing associate position in Vernon BC. The successful applicant will be an enthusiastic, energetic individual, have more than 2 years experience in all areas of general dentistry and have an appetite for continuing education. Our newer, well equipped office is fully computerized (paperless/digital radiographs) and has a Cerec machine, microscope and 2 soft tissue lasers. We have a committed staff and a large, loyal patient base.

For more information call 250-260-0281 or email dr.rex@shaw.ca

… it’s also a great place to work.

General Dentist Opportunities Labrador-Grenfell Health offers a unique opportunity to live and work in a region of Atlantic Canada. We combine the peace and quiet of a rural setting with modern equipped facilities and a strong sense of community spirit. This is a perfect location to gain valuable experience in an innovative work environment.

We are responsible for a full range of services, including community health, long-term care and acute care in Northern Newfoundland and Labrador.

We are currently looking for the following professionals:

General Dentist

Permanent Full-Time, St. Anthony

STONEY CREEK, ON

Part time opportunity to join our well established dental practice in Stoney Creek, Ontario.

Our practice provides a high quality of care in all aspects of dentistry, including oral sedation, digital xrays,computerized charting, an extensive soft tissue management program, oral surgery and implants.

Searching for a caring individual with strong clinical and communication skills to join our team Monday through Thursday evenings with the potential to lead to more hours during the days.

Please forward curriculum vitae to dentallinc@gmail.com

EDMONTON, AB Looking for an associate (part/full time) to join our group of multidisciplinary practices which are focused on the highest quality of patient care and using the latest technology available. We are looking for a self-motivated, high-energy, clinically strong candidate who is interested in learning and continuing education. This is a great opportunity for the right candidate to grow with our expanding group and to work in a great environment. Buy-in opportunities are also available for the long-term associates.

If you are interested, please email your CV in confidence to edmontondentalcareer@gmail.com

Salary ranges from $136,434 to $163,723, depending on years of experience and service. Incentives include an annual retention bonus ranging from $6,750 to $20,500 (depending on location and years of service), six weeks paid leave and three weeks paid education/conference leave in a 12-month term.

Applicants must have experience in general dentistry, be eligible for registration with the Newfoundland and Labrador Dental Board and be able to submit a satisfactory Certificate of Conduct.

If a career path with a sense of adventure appeals to you, we need to talk. For information on joining our team and our incentive package, which includes assistance with relocation expenses, please submit your resumé, complete with references and stating competition number 2013000377S , to: Labrador-Grenfell Health Human Resources St. Anthony, NL A0K 4S0 Phone: 709-454-0347 Fax: 709-454-3301 hr@lghealth.ca

www.lghealth.ca

SPRING 2014

• oralhealthLABS

www.oralhealthgroup.com

27

Practices & Offices BAYVIEW AND SHEPPARD TORONTO, ON

Prestigious location steps from Bayview Village, Hwy 401, Subway line and tremendous construction of condominiums all around. Detached 2 story building fully renovated and equipped with 3 spacious operatories on main level and fully equipped lab +1 OP on lower level. Ideal real estate investment opportunity for a dentist.

E-mail: dental325@gmail.com or tel: 416-318-3499.

INGLESIDE, ON

Opportunity to purchase 1600 square foot space or lease a 1500 square foot space within an established area pharmacy in the rural under serviced area of Ingleside, ON. Space available is within the commercial hub of Ingleside and very close to the new medical building to be completed by the Fall. Ingleside is within 20 minutes of Cornwall and 1 hour from Ottawa and Montreal.

Please call Bryan (Pharmacy Owner) at 613-537-2477 or email me at inglesidepharmacy@hotmail.com for more information.

ASSOCIATE BUY IN – CENTRAL BC

Opportunity for EXPERIENCED associate to purchase a busy, established dental office by working it off over time. 5 ops., hygiene, good income.

Professional evaluation done. Price negotiable.

Owner retiring.

Call 1-250-847-4934.

Advertisers’ Index 3M Espe . . . . . . . . . . . . . . . . . . . . . IFC ASDA – American Society for Dental Aesthetics . . . . . . . . . . . . . 6 Ivoclar Vivadent . . . . . . . . . . . . . . . . . 7 Sirona . . . . . . . . . . . . . . . . . . . . . . . . 8-9

TORONTO, ON

Ops for lease in downtown office; close to Subway, Universities, Hospitals; suitable for specialists or general dentist with own patient base.

Please email: hans.nita@sympatico.ca

www.oralhealthgroup.com

DENTAL MARKETPLACE HELP

Equipment FOR SALE:

Cerec Crown System: – CEREC 3D by Sirona.

Model No. 5811000 – Cerec MC XL by Sirona Model No. D3439 – Glaze Oven: Ivoclar Vivadent Programat CS ALL IN AMAZING CONDITION. ANY RESONABLE OFFER CONSIDERED. SHIPPING NOT INCLUDED. For more purchasing inquiries please contact: Jovi-Lynn Nojeda by either email: jovilynn.nojeda@adamdentalclinic.ca or by telephone: 867-873-2775.

FOR SALE Cerec MC XL/ Bluecam (2009); less than 20 crowns milled, no marks or scratches, has been maintained through service contract with dealer, includes 10 extra burs and 45+ new Cerec Blocks, asking $50,000.00 obo.

Please contact Di-Anna. info@gentlefamilydental.ca or call 780-468-6937.

www.oralhealthgroup.com 28

oralhealthLABS •

SPRING 2014

www.oralhealthgroup.com

YOUR ADVISOR IS IN KAREN SHAW TEL: 416-510-6770 FAX: 416-510-5140 E-MAIL: kshaw@oralhealthgroup.com TOLL FREE CDN: 1-800-268-7742 ext 6770 TOLL FREE USA: 1-800-387-7742 ext 6770 WEBSITE: www.oralhealthgroup.com