Articulator Volume 23, Issue 3

ARTICULATOR MDDS Connections for Metro Denver’s Dental Profession

1st Quarter, 2019 Volume 23, Issue 3

GETTING DOWN TO BUSINESS 12

Tax TimeHere We Go Again

16 Hiring With Purpose

21

Maximize Your Time and Money - A Look Into Acquiring Practice Financing

to Take Advantage 22 How of Today's Marketing Trends: An Old-fashioned Approach

B

Take a Closer Look

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New Graduate 1st Year Rate

All malpractice policies are not created the same

There are a lot of differences between being a Member of the Trust and just another policy number at a large, commercial carrier. Both give you a policy the Practice Law requires, but that’s where the similarity ends. Consider…

Who do I talk to when I have a patient event, claim or question?

The Trust: Local dentists who understand your practice, your business and your needs.

Them: Claims call center (likely in another state).

Do I have personal input and access to the company?

The Trust: Yes. You are represented by dentists from your CDA Component Society giving you direct, personal access to the Trust.

Them: Yes, via their national board.

How much surplus has been returned to dentists in Colorado?

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

Them: $0

Besides a policy, what do I get when I buy coverage?

The Trust: Personal risk mitigation training, educational programs and an on-call team that “speak dentist.”

Them: Online support.

Do I have to give my “Consent to Settle” a case?

The Trust: All settlements are based on the best interests of the dentist, patient and Trust Members.

Them: Read the fine print; ask about their “Hammer Clause.”

How many years has the company been serving Colorado dentists?

The Trust: 29 years. Established by dentists in 1987.

Them: It’s hard to say... they tend to come and go.

Protect your practice.

Call the Trust today.

Dr. Randy Kluender · 303-357-2602 Dr. H. Candace DeLapp · 303-257-2604 www.tdplt.com

1st quarter 2019

what's inside?

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pg.16

10 Five Choices You Can Make to Influence Positive Change

12 Tax Time-Here We Go Again 16 Hiring With Purpose 19 For Less Decay, Try Something Sweeter 21 Maximize Your Time and Money A

Look Into Acquiring Practice Financing

22 How to Take Advantage of Today's

Marketing Trends: An Old-Fashioned Approach

24 Minimum Preparation = Maximum .

Longevity

departments

Advertisers Directory

ADS Precise Transitions http://adsprecise.com........................ 31

Dentists Professional Liability Trust of Colorado http://tdplt.com..........Inside Front Cover

Berkley Risk Services of Colorado http://colorado.berkleyrisk.com............ 5

Denver Implant Study Club http://disc.events/............................. 20

Carr Healthcare Realty http://carrhr.com.................. Back Cover

Gheen & CO CPA http://dentistcpafirm.com..................... 4

Colorado Dental Association http://cdaonline.org.......................... 29

Healthcare Medical Waste Services, LLC hcmws.com....................................... 23

Copic Financial Services Group http://copicfsg.com............................ 11

Northwestern Mutual http://shawncopeland.nm.com........... 27

CTC Associates http://ctc-associates.com/.................. 25

SAS Transitions http://sastransitions.com...................... 5

4 President's Message 6 Reflections 7 Member Spotlight 8 Member Matters 14 RMDC Wrap-Up 28 Tripartite News 30 Event Calendar 31 Classifieds

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

Editorial Policy All statements of opinion and of supposed factare published under the authority of the authors, including editorials, letters and book reviews. They are not to be accepted as the views and/or opinions of the MDDS. The Articulator encourages letters to the editor, but reserves the right to edit and publish under the discretion of the editor.

Advertising Policy MDDS reserves the right, in its sole discretion,to accept or reject advertising in its publications for any reasons including, but not limited to, materials which are offensive, defamatory or contrary to the best interests of MDDS. Advertiser represents and warrants the advertising is original; it does not infringe the copyright, trademark, service mark or proprietary rights of any other person; it does not invade the privacy rights of any person; and it is free from any libel, libelous or defamatory material. Advertiser agrees to indemnify and hold MDDS harmless from and against any breach of this warranty as well as any damages, expenses or costs (including attorney’s fees) arising from any claims of third parties.

Inquiries may be addressed to: Metropolitan Denver Dental Society 925 Lincoln Street, Unit B The Articulator is published quarterly by the Metropolitan Denver Dental Denver, CO 80203 Society and distributed to MDDS members as a direct benefit of membership. Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com Š2018 Metropolitan Denver Dental Society Printing Dilley Printing

Member Publication

3

PRESIDENT'S LETTER

Gentle Musings of a Gum Gardener: What it Takes to be a Successful Dentist and the RMDC

By Brian Gurinsky, DDS, MS

A

fter nearly twenty years of practicing dentistry, I have ruminated and come to the sad realization that I don’t know much! However, what I do know is (lean in real close) that dentistry is hard. No, I am not referring to the technical skills. Those skills can be cultivated with time, continuing education and practice. I am referring to all the hats we must wear and wear well in order to succeed.

Being a successful dentist means having a great team. Easy to say, but not easy to find. I have had some terrific team members over the years as well as some less than ideal ones. How do you find and retain good people?

How do you build a positive and productive work environment? I’m not going to profess to have the answers, but my enjoyment of dentistry has been directly tied to having a great supporting team.

Being a successful dentist means connecting with your patients. Lots of different personalities sit in our chairs, so this can be tougher than you might think. We also bring our own personality strengths and weaknesses to the table. How do we exude confidence without seeming arrogant? What does it take to gain the trust "Being a successful of a patient? How do we stay patient with the individual dentist means having who asks a million questions the skills of a small when there is a full waiting business owner room? The list goes on, but I and understanding think you get the picture. finances."

Being a successful dentist means having the skills of a small business owner and understanding finances.

This is one reason why DSO's are attractive to many dentists. They are generally much better at the business side of dentistry than most of us.

How many of you were finance, accounting or management majors in college? Me neither.

So how do you learn these skills? Much like not doing your own lab work and aligning yourself with a good lab, you must start by aligning yourself with good support people including a CPA, financial advisor, mentor and attorney. I believe it is not only nearly impossible to learn all the professional business skills you need, but also not an effective use of our time to master them. That means we must seek out help from experts in other fields. I am a self-admitted poor delegator so take it from me! However, clinical skills, team management, people skills and communications are things we can’t delegate. Those skills are imperative to learn and cultivate in order to be successful. It seems overwhelming. Where do you go to learn those skills without missing a lot of work and spending a fortune?

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As we are closing the book on another successful RMDC, I want to give kudos to the MDDS professional team and volunteers who designed a continuing education curriculum that included opportunities to get better at all the skills of being a successful dentist. It’s easy to put together a wellattended program 100% dedicated to clinical dentistry. However, the RMDC Program Committee focuses it's efforts on creating a well-rounded curriculum for both dentists and team members including clinical, business, team building, marketing, communications, wellness and personal growth. These courses are planned over a year in advance and it is not by sheer luck that they address all these needs. For a small investment (free, if you are an MDDS member), you can earn up to eighteen hours of CE in your own backyard in just three days.

As MDDS President, I’ve had an opportunity to "see how the sausage is made" and it takes an incredible amount of dedication to the improvement of our profession. I would highly encourage you to get involved by volunteering for an RMDC committee - convention arrangement, programming or exhibits. Put your stamp on our next meeting. It is not only fun but eye opening.

There’s a

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REFLECTIONS

How Our Words Change Our Life

By Amisha Singh, DDS

S

itting at the Awards Gala & President’s Dinner treat ourselves with grace. Our internal speech defines who we are as during the Rocky Mountain Dental Convention doctors, leaders, parents, spouses and loved ones. Change begins here.

(RMDC), lost in amazing conversation with Words That We Say to Our Team colleagues who have become friends, I found A group of people show up every day to help turn my dreams into a myself in awe. Less than a decade ago, the reality that reality. Some of them work with me in my practice. Others work in I am currently living was a only dream that I viscerally different arenas of my life. I could not do half of what I do or what I yearned for. It was a dream I carried in my heart and pride myself on, without their support and skills. The words I use with silently cherished. On December 1, 2010, I got the call from University them not only carry the power to change the trajectory of their lives, of Colorado accepting me into dental school; something I had prayed they can change the trajectory of mine as well. Those words give me for became a reality, and the rest of my life was set in motion. I the power to show gratitude, to express support and to encourage. We remember calling my parents, tears in my eyes of relief, of gratitude, of should wake up every day aspiring to use our words to build, educate, something I could not yet name. This is how life changes: in tiny, silent, support and to create an oasis. The words we choose to use with others imperceptible moments. And sometimes we wish that those moments can send someone to dental school, encourage them to start their own would announce themselves, carrying the gravity that bends time, business or change their life in unimaginable ways. yelling “THIS IS YOUR LIFE CHANGING.” But What will you do with your words today? they never do. Their weight is often seen decades "What we choose to do later as they stand shining out in the timeline Words We Say to Our Patients that becomes your life. on a daily basis, how In the midst of days blending into weeks, it is easy to we choose to react, forget how pivotal our profession is in the world of I am blessed. Infinitely, heart-wrenchingly what we choose to healthcare. Our patients see us for preventative care blessed. But sometimes, in the turmoil of the more often than any other medical provider. We have daily urgent tasks that swallow the important focus on becomes our the ability to intervene before heart attacks, strokes, ones, in the middle of difficult crown seats or life. What we adopt as mental illness, cancer and so much more. The bacteria practice management issues, the reality of that we fight on a daily basis can travel to create abscesses, blessing gets lost. In these small moments which habit and what we do aggravate diabetes, trigger sepsis, destroy both bone hold the potential to become pivotal, the words consistently defines us." and confidence alike. We protect our patients and their we say and the actions we carry out define our health. But the words we use to describe our work can reality. The choices we make become our reality. often diminish our work. “A small filling” or “just a hygiene visit” takes Lisa Nichols said, “Our lives are the culmination of our decisions and away from what we do and can lead to a disservice for our patients. As our actions.” Isn’t this is the truth? What we choose to do on a daily doctors we are also educators and advocates for the health of those who basis, how we choose to react, what we choose to focus on becomes our walk through our door and lay their trust in our hands. life. What we adopt as habit and what we do consistently defines us.

I argue, the most important choices we make are our words. Human Thinking back to that younger version of myself who answered the communication is single-handedly the most impactful contribution we phone and then answered the call to join this profession, I remember make because it is something we consistently do. Words have the power her dreams vividly because I am living them. She used to wish that to change and shape our reality. the older version of herself, the one that “made it,” could go back and Words We Say to Ourselves whisper in her ear, “Everything will be okay. This will become your The most important relationship we will ever have is the relationship reality.” But the truth of the matter is, she is the one that created this we have with our self. This relationship sets the stage for all others. If we reality with the power of her daily decisions. I exist because she chose do not have a healthy internal dialogue, it will impact our position with her words and her actions carefully. So now the question is, who can I other important people in our lives. Our self-talk should be as kind, as become in yet another decade with the support of my daily decisions. supportive and as constructive as we aspire to be with others. We should Who will my words transform me into?

KEEP UP-TO-DATE EVERYTHING MDDS

Follow us @ mddsdentist today!

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MEMBER SPOTLIGHT Lindsay Compton, DDS

Generations Family & Cosmetic Dentistry Arvada, CO

In a historically male industry, why do you think it is important for women dentists to be involved at the local, state and national levels?

"I feel that leadership needs to reflect who it represents. Every individual brings something unique to dentistry and deserves a voice."

What is your favorite part about your job?

"My patients and team are my favorite part of my job. When I started in dentistry I had no idea that I would gain a family."

What is your biggest challenge and/or opportunity as a small business owner?

"My biggest challenge is forming my non-staff team. These are my marketers, designers, printers, accountants, real estate agents and so on. In my office we have a set of core values, a vision and a mission statement. If my outside team doesn’t align, there’s a disconnect and it won’t help me grow and be my best."

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

"When I was 10, I said I would either be a dentist or a ballerina. I think everything turned out for the best."

As the next RMDC Chair, can you give us a sneak peak at what is in store for the 2020 convention?

"Nope. It’s top secret! Just kidding!

The convention in 2020 will have more options in course length and topic than it has previously. Dentistry is more diverse in appearance and practice than it ever has been. The convention needs to evolve to meet those needs of dentists.

I also hope to make more opportunities for like-minded dentists to connect."

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MEMBER MEMBERMATTERS MATTERS

Give Kids A Smile Day (GKAS)

New Members, Welcome!

Dr. Claire-Marie Bender Dr. Marcy Blalock Dr. Amy Boeckermann Dr. Alireza Bonakdar Dr. Erik Chestnut

Dr. Jerod Leff poses with a patient at Kids in Need of Dentistry’s (KIND) Give Kids a Smile event.

Dr. Ping-Ping Feng Dr. Leonardo Galvez Ramirez Dr. Andrew Glynn Dr. Kelly Halligan Dr. Timothy Hardy Dr. Kentaro Ikeda Dr. Heather Jenkins Dr. Young-Won Jo Dr. Mary Johnson Dr. Reena Kandyala Dr. Sridevi Kaul

Volunteers perform an oral health check on a patient at the Dahlia Campus for Health and Well Being.

Dr. Kristen Lowe Dr. Jeffrey Marlor

MDDS/CDA Snowshoe Event

Dr. Richard Myers Dr. Jayashree Nakkana Dr. Afsaneh Noori Dr. Taylor Postler Dr. Michelle Rowe Dr. Kathleen Rowley Dr. Shaheen Shafagh Dr. Maha Sidhom Dr. Natalya Starkle

Dentists from around the state braved the cold for the MDDS and CDA New Dentist Committee Snowshoe Hike at Echo Lake Park.

Dr. Megan Su Dr. Shelby Tesar

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MDDS PRESENTS:

DENTAL SLEEP MEDICINE MINI RESIDENCY - Early bird pricing - $5,995 - for members by April 12, 2019 - Earn 48 hours of continuing education - Three interactive weekend courses:

o September 27-28, 2019

o November 8-9, 2019

o February 21-22, 2020 - Internationally recognized dental sleep medicine clinicians: Drs. Terry Bennett, Chase Bennett and Mayoor Patel Learn more and register at mddsdentist.com/event/sleepresidency Continued on page 11.

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FEATURE

FIVE CHOICES YOU CAN MAKE TO INFLUENCE POSITIVE CHANGE

By Dean Savoca, M.Ed., BCC, CSP

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ncrease revenue, grow patients, plan strategically, and improve relationships: these are primary objectives of many practices that want to make positive changes. But in discussing these objectives, many organizations tend to focus on the problem of what’s not working. Instead, the approach I have found to be most successful is to focus on what is working.

When a computer breaks, we troubleshoot or use trial and error to fix it. A computer is a machine. This method of “fixing” works well. This method is not always as effective when dealing with human systems.

“The significant problems we face cannot be solved at the same level of thinking we were at when we created them.” Albert Einstein This traditional “fixing” approach to organizations worked when leaders and practice owners were primarily managers of resources: payroll, schedules, budgets, maintaining equipment and supplies. In today’s world of workgroups, collaborative environments drive productivity and leaders are more than just problem-solving managers. They are expected to build employee engagement in addition to practicing dentistry. In response to these broader expectations, a new model for change has evolved: Appreciative Inquiry (AI).

Appreciative Inquiry is a strength-based approach to change that

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engages and energizes your team as they focus on what they are doing right, and how they can build on past success to produce future success.

So, what happens to the problems? Problems are recognized as a desire for something else. Problems are dissolved rather than solved.

When we focus on the problems, we get tired and often discover more problems. By focusing on what is appreciated, your organization discovers its strengths and clarifies the productive direction it wants to go.

“The task of leadership is to create an alignment of strengths, making our weaknesses irrelevant.” Peter Drucker To discover the roots for this change approach, examine the roots of the words “Appreciative Inquiry.” Appreciate means to value. It can also mean to increase in value - as with a house or financial investment. Inquiry means to explore or discover, to ask questions, to be open to new possibilities. The assumption underlying AI is simple: every human system has a core of strengths that is often hidden and underutilized. When the organizational strengths are discovered and utilized, it provides a sustainable source of positive energy that drives both personal and organizational change. AI is like a search engine, searching for the strengths and successes of a human system. When the strengths are linked to an agenda for change, rapid and sustainable positive change is possible.

Choose to study what IS working in your practice.

You can choose to study why productivity has decreased or why your best people are leaving.

You would understand the problem better, but not necessarily have a clue of how to change the human system. Ask instead, “Why do star dental assistants stay? And what do the stars do to produce results?”

Then you can start getting ideas about what works and can focus on what will keep productive, driven people.

Choose to ask “appreciative” questions.

"Appreciative Inquiry is a strength-based approach to change that engages and energizes your team as they focus on what they are doing right, and how they can build on past success to produce future success."

Positive questions lead to positive change. The questions we ask can produce energy or drain it, increase productivity or reduce it, enhance self‐confidence or deplete it. Consider this example I use with my kids after school. Instead of asking “How was your day?” I ask, “What was the best part of your day?”

The first question is typically answered with a “fine," but the second question generates positive energy around the experience. The questions we ask are influential. They determine where we place our attention. Effective leaders ask questions that generate enthusiasm and action aligned with the future vision they want to create.

Choose to stimulate positive discussion and action.

What we talk about is what we focus on and what we focus on leads to action. Using time and energy to describe the bad relationships can be exhausting and demoralizing. Instead, describe past productive work

relationships and identify the desirable relationship qualities. The change starts in the discussion itself and the energy builds towards positive action.

Choose to BE the change you want to see.

Identify the change you want to see and frame it in the positive. Here’s how it works. Saying “I want staff to stop complaining and gossiping” becomes “I want a work environment where everyone feels appreciated and respected.” Leaders can start a meeting by complaining about gossiping and lack of trust or can open a meeting with a story about trust in action or ask a question that provides others with the opportunity to share a positive experience.

Choose to celebrate realizing your vision.

When actions are taken toward your vision, reinforce and build on the success by celebrating it and building on what is working, and the Appreciative Inquiry process continues.

About the Author Dean Savoca, M.Ed., BCC, CSP is president of Savoca Performance Group, the performance development partner for hospitality industry organizations who want highly-effective teams that are focused, aligned and inspired. A 25-year veteran of the meetings and events industry, Dean speaks across the country on leadership, influence and development. Mr. Savoca will be leading the MDDS Board of Directors in the 2019 Applied Strategic Plan.

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FEATURE RMDC SPEAKER

HERE WE GO AGAIN

By Luke Gheen, MBA, CPA

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t’s the time of year that many dental professionals dread: tax time. After a year of pushing your practice forward and providing world-class care, you now must relinquish too much of your hardearned income to the United States Treasury. Most dental professionals are happy – even proud – to pay their “fair share” of tax. But why does it often feel like an “unfair share"? For most, if their taxes could be substantially reduced, their whole perspective on work, length of their career and retirement aspirations would alter. Is significant tax reduction possible?

The Importance of Planning

“Buy some more equipment” is not tax planning. “If you don’t like your tax bill, make less money” is not tax planning. So, what is tax planning?

It’s a proactive, systematic method of forecasting, communication and action – directed by your CPA – that should be accomplished throughout the year (not after the fact). There are dozens of valid ways to save money in taxes. Not all of them are right for you, and not all of them can be done after the year is over. With the help of a trained professional, you can identify hidden treasure and lower your tax bill so more of your wealth stays in your pocket.

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Sunken Treasure: The Business Deductions You Are Probably Missing

Before you spend another dime, create a process for recording each and every expense. Once you see where your money is going, you can work with your CPA to maximize your deductions. Business owners often overlook savings opportunities. By reviewing the following categories you can see what might apply to your situation.

Costs of Maintaining a Home Office Running a company requires round-the-clock availability, and you are probably called upon at all hours to resolve employee and patient concerns. Chances are, there is an area in your home specifically dedicated to business activities. If not, it is worthwhile to establish one. Even if you already have space set aside on the premises of your business, you can deduct expenses associated with a home office on your personal tax returns.

Tax Deductions for Business Vehicles As with any major equipment purchase, the best time to consult with your CPA is before you buy a vehicle. The decision to buy versus lease

can impact your tax liability, and cars and light trucks offer smaller tax benefits than their larger counterparts. Bigger tax deductions are typically available for vehicles over 6,000 pounds, so you may discover that the extra cost of a full-size truck or van is worthwhile once you calculate tax savings. For context, the curb weight of an average midsize car is approximately 3,500 pounds while a full-size truck or SUV weighs 5,500 pounds or more.

Expenses Related to Branding and Marketing

your spouse is also your employee, you have even more opportunities to save. Both you and your spouse can continue to contribute to traditional IRAs, Roth IRAs or qualified plans sponsored through your company. You will enjoy the standard tax savings that come with these plans and your business can take deductions for contributions made on behalf of both you and your spouse. With some advanced planning, some retirement plans can be stacked together to create tremendous savings opportunities. Talk to your CPA to learn more.

Getting the word out about your practice should be a big focus each Showing Appreciation on Service Anniversaries year. After all, it doesn’t matter how good your services are if nobody Employees take note of their years of service, and it gives them a boost knows about them. In addition to traditional advertising methods when you notice their commitment to the organization. You may be such as billboards, radio and print, digital marketing offers extensive able to deduct the cost of length of service awards if you give a gift opportunities to make connections with your target demographic. instead of cash. The item must be valued at $400 or less, and you are Creating digital content like articles, images and videos is critical for limited to one gift per employee every five years. This offers plenty of attracting clientele. When added to must-haves like business cards room for creativity: you can send flowers, present a piece of jewelry or a and brochures, marketing quickly gets expensive. Fortunately, many watch or give staff members a selection of items from which to choose. of these expenses are tax-deductible. The basic costs of marketing materials aren’t your only opportunity Saving on Taxes While Seeing the World "For most, if their taxes for tax savings. You may also be able to include You are already deducting your business travel could be substantially expenses associated with hiring professional graphic expenses, but you may be missing out on a chance reduced, their whole designers, content creators, videographers and the to save even more. It is becoming quite common like. to combine business travel with leisure trips to perspective on work, length of their career and bring down the costs of both. For example, if you attend a conference in an exotic location, your Lowering Taxes with Training retirement aspirations travel expenses are likely to be deductible. You can and Development would alter.

Is significant increase your savings by inviting your family along Building a practice from the ground up requires a and extending the trip a few days. Their travel won’t specialized skill set, but you need an entirely separate tax reduction possible?" be tax deductible, and the extra non-working days set of skills to manage the organization for longyou take can’t be deducted, either. However, when term success. Though you probably already have a costs are allocated appropriately, the total out-of-pocket cost of your solid base of knowledge, continuous learning can ensure you overcome family vacation will be substantially lower. When you use this method unexpected obstacles. Some practice owners pass up training and of combining business and personal travel, make sure your recorddevelopment opportunities such as classes, workshops and seminars keeping is flawless. Your CPA is an important partner for this strategy, because the associated expense just doesn’t fit their budget. Fortunately, ensuring that the business deductions you claim accurately reflect your tax regulations are designed to make learning affordable. The costs of travel. training and development are often tax deductible, and that’s not all.

You may be able to write off your investment in books, trade magazine Identifying and applying all possible deductions is a bit like searching subscriptions and dues paid to professional organizations if you can for sunken treasure. Many potential savings opportunities are well show they are relevant to your work. hidden. However, when you put the time and energy into locating the treasure, the financial rewards are well worth your efforts.

Bringing Family on Board One of the greatest joys of owning your own company is the opportunity to work side-by-side with your loved ones. Many small business owners About the Author rely on their spouse and children to manage day-to-day operations.

Luke Gheen, MBA, CPA is a longtime resident of Colorado with Parents enjoy extra time with their kids, and they have a chance to extensive corporate finance and accounting experience. He graduated pass along critical life skills. Children get a chance to earn their own with a bachelor's degree in Business Administration from the University money while learning the inner workings of the business world. If your of Colorado in 1999, and received his MBA from the University of employees are also dependents, you may qualify for significant tax Colorado in 2007. Luke started Gheen & Co., CPA in 2010. Luke is a savings. There are some nuances to claiming these types of tax benefits, member of the American Institute of Certified Public Accountants. He so be sure to connect with your CPA before hiring family members. relishes spending time with his wife, three sons, daughter and extended family.

Retirement Accounts

Setting funds aside for retirement is a financial priority, and business owners have a variety of options for tax-advantaged accounts. When

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The 2019 RMDC kicked off with an electrifying rendition of the national anthem, announcements from the 2019 Convention Chair and interactive lecture on wellness from Dr. Uche Odiatu.

OPENING SESSION

RMDC CLASSES

The 2019 RMDC offered a packed schedule of continuing education courses for dentists and the whole dental team. Attendees learned the latest techniques in hands-on courses as well as trends, theories and technologies in lecture courses.

EXPO HALL

The RMDC Expo Hall featured the newest products and technologies from over 260 exhibiting companies at over 300 booths. Attendees were able to earn CE at the new Summit: CE & Demo Stage in the center of the exhibit floor.

I PARTY FRIDAY NIGHT

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RMDC attendees danced the night away at the RMDC Friday Night Party.

RMDC19

BY THE NUMBERS!

85 people participated in the bull riding contest

s

2,706 RMDC Mobile App Users

500

ba popgs of enjo c ye orn

Sna d duri n ck T ime g

252 EXHIBITING COMPANIES

755 attendees

at the Friday Night Party

+1,600 hotel nights booked around Denver

+14,085 Average steps of RMDC staff

+75,000 CE

CREDITS EARNED OVER THE COURSE OF RMDC

BE PART OF THE GROWING NUMBERS NEXT YEAR!

00

61

world renowned speakers

4,245

VISITORS TO THE EXPO HALL ON FRIDAY

38

Avg. temperate in Denver during RMDC

January 23-25, 2020

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FEATURE

HIRING

WITH PURPOSE

By Amisha Singh, DDS

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ne of the most challenging parts of owning a practice, or any business for that matter, is staff.

Words like "turnover" and "ghosted interviews" are the things that practice owner nightmares are made of. When a team member leaves, the loss can seem devastating, both emotionally and financially. According to a study conducted by the Center for American Progress, the average cost of replacing an employee is about 20% of their salary. I postulate that in dentistry, it may be even higher. Anyone who has had a new team member throw away a Garrison ring – or worse, a handpiece – will agree! The emotional loss can surpass even the financial

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loss. In as specialized a field as dentistry, we heavily rely on our team.

They are integral parts of our patient care. And they can become integral partners to support and elevate the care we as doctors provide. This stands to remind us that our team can also be one of the most rewarding parts of practice ownership. The ability to change lives, to be an oasis of growth and development, to provide a vehicle on which a team member can surpass even his or her greatest professional expectations: it is a privilege and a humbling experience. As the African proverb goes, “If you want to go quickly, go alone. If you want to go far, go together.” In dentistry, the team is a perfect example of this sentiment.

When I started my own practice, creating a healthy, happy, empowered team was the crux of my mission. They are the reason I wake up each morning. And as long as I continue to come to work to contribute to them, they come to work to contribute to our patients. They are my “why;” our patients are theirs. The team we have right now is small but mighty and are more powerful and inspiring than I ever could have imagined. However, the road to getting here was challenging at times. It was riddled with turnover, 15-minute notices and more stories than could fill a happy hour. Along this rocky journey, I learned some vital tips on hiring which has drastically changed my process and my approach. When I hire now, I hire with my “why” in mind.

fit. Remember, they are evaluating your practice as much as you are evaluating them. You do not want to hire someone who will not be a good fit. Use this to your advantage and tell them about your practice philosophies and expectations. This can be conducted at your practice or in a public setting. Many practices include other elements such as essays, team lunches, working interviews and assessments. Crafting the interview process can feel overwhelming. But an interview process which is well tailored to the position for which you are hiring is vital to finding the right candidate. The first step in finalizing the interview process for a particular position is to create a wish list for the ideal candidate.

In my favorite TED Talk of all time, Simon Sinek says, “if you hire people just because they can do a job, they'll work for your money, but if they believe what you believe, they'll work for you with blood and sweat and tears.” To create a true team, a vision must align them. A portion of this vision comes from you articulating this as a leader. Another portion comes from their vision for life aligning with your "According to a study vision for the work your team does. Both have to be conducted by the embedded into the hiring Center for American process.

Do they need to have a keen attention to detail?

Progress, the average

So how do you implement cost of replacing an a process which captures your potential team employee is about member’s “why?” Well, 20% of their salary. it is a multi-part process.

When we hire, especially I postulate that in in markets with booming dentistry, it may be economies, we know we are often vying for the even higher." best candidates. Due to this pressure, sometimes we pull our punches. One positive interview, some small talk and an alma mater in common, and we may cross our fingers and be relatively assured of the candidate’s caliber. But without precision comes inevitable regret. This employee will be a partner in patient care, a brand ambassador and so much more. According to the Pygmalion Effect, or Self-fulfilling Prophecy Effect, first researched by the Gallup Leadership Institute meta study, expectations set by leadership directly impact the performance of groups. It is exceptionally important to set high expectations from the get-go and then create reliable and consistent parameters of accountability. We want candidates who will rise to the occasion, who will step outside of their comfort zone to grow and contribute to our practice. Setting those expectations initially during the interview process is vital and directly indicative of future performance.

One part of setting those expectations is an interview process which involves multiple levels of consideration. The basic infrastructure that most practices start with involves an initial phone call to remove candidates from the pool that do not have the expected level of education, experience, communication skills or professionalism. Questions asked during the phone interview should be targeted at this information. The phone interview will hopefully be an effective way to get candidates out of the pool who tend to ghost, or not show up for scheduled interviews (yes, it’s a thing unfortunately). The next step is typically an in-person interview. This allows candidates who have done a great job with the phone interview to get to know you and your practice and assess their

In the job description, include instructions to use a specific word like “apple” in the subject line of the email. Before ever speaking to the candidate, upon receiving the resume, you will know if they have an eye for detail.

Will they have fantastic communication skills?

Include role-play during the in-person interview to see how they will react to unexpected situations.

Does your office believe in a flattened hierarchy? Will this person need to treat everyone with respect regardless of their title?

Make the interview a working lunch and see how they talk to the restaurant staff. You will be able to assess if the candidate is considerate of others, how they respond to problems and so much more.

Will they be able to multitask?

Prepare a mini-task or evaluation (not patient or practice based) which tests the skills you need them to have.

The multiple steps of the interview should be intentionally designed to gain insight into a particular need for the position. But the interview process goes beyond knowing the candidates. It also involves knowing your needs as a practice owner and a leader. Do you have a tendency to micromanage and therefore need someone who is open and receptive to frequent check-ins? Do you need someone to offset your visionary tendencies by paying attention to the details and research (or vice versa)? Do you respond well to an individual who is direct and blunt?

What do you need to feel fulfilled within the parameters of your work?

Personality assessments are ideal for both an assessment of the candidate and of yourself. There are many assessments to choose from: Meyer Briggs, DISC, Core Motivators, Strength Finders, the list goes on. DISC is a popular choice because it is quick, easy, inexpensive (even free!) and extremely informative. Whichever assessment you choose, as a leader and owner, you should take it first. This will help you note your own personal tendencies and be able to choose a compatible team member. It will also help you assess your weaknesses and hire strategically to complement those skill sets.

When you consider your “why,” the foundation on which you built your practice, you will find team members who are more than just employees. You will find advocacy, insight and loyalty. You will be better equipped to contribute to their lives and help them achieve their goals.

Alignment on a deeper level than items like pay and schedule will help your practice accomplish something greater than you imagined. Hiring a team with purpose is the key to that potential.

Continued on page 18.

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Continued from page 17.

THINGS TO BE STRICT ABOUT

THINGS TO BE FLEXIBLE ABOUT

Loyalty to a Practice or Profession

Skill Set

Candidates who jump from ship to ship and cannot hold a job or candidates that will readily badmouth a previous office are telling you something about their habits. Listen to them.

Your Gut Feeling

Like with most things in life, your instincts will reveal an infinite amount about your candidates. If you sense something is wrong, it usually is. A great way to verify an uneasy feeling is checking their social media. Lots of secrets tend to lurk there.

Background Checks

Yes they are annoying and cost money, but they can reveal vital information which may be non-negotiable points.

Checking References

It seems mundane but for the wrong candidate, this step will provide key insight.

Ask probing and hard questions to gain the most value from reference checks such as “Would you rehire this person” or “What is the biggest challenge this person faces in their professional life?” Ensure that the references are professional and are people who oversaw the employee (and not simply colleagues).

The Opinion of Your Team

How the candidate will fit into the culture of your practice and how they impact their fellow team members is perhaps one of the most reliable predictors of success. Hire as a team, ask your team their opinions and you will increase longevity and decrease turnover.

Morals and Ethics

If a candidate insists on giving notice even to a currently dissatisfying job, you can rest assured they will offer you the same courtesy. This is important. Karma is real.

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Remember the widely known philosophy, “you can teach skills but you cannot teach personality.”

Time Frame

Sometimes our hiring feels impending and time is absolutely a consideration. But for the right candidate, would you be willing to wait?

How much impact will a few extra weeks have on your business? It is worth asking.

Circumstance

If you worry about losing the perfect candidate due to inability to afford their pay or distance from their home or some other caveat, ask them the “In what circumstance” question. This question works wonders in the world of hiring when we hear the word “no” (both as employers and employees). If a candidate says no, ask them “In what circumstances would you take this job?” and then let them speak. They will tell you if there is wiggle room, work out flex schedules and create “yes” answers for you. You simply need to ask.

About the Author Amisha Singh, DDS is a Denver native and loves living in beautiful Colorado.

She owns Smile Always Dental, a general dentistry practice in Parker,=. She is an active member of the American Dental Association, Colorado Dental Association and Metro Denver Dental Society. She was recognized as one of the 2018 Top 10 Under 10 ADA Dentists nationally. She serves on the CDA House of Delegates, on the ADA Dental Wellbeing Advisory Committee and on the MDDS and CDA Membership Councils. She is the CDA New Dentist Committee Chair Elect. She is also a blogger and professional speaker who works with IgniteDDS.

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FEATURE

For Less Decay, Try Something Sweeter

By David Bashford, Esq.

A

few things that we know.

We spend every bit as much awake time with co-workers as we do with family. No surprise, then, that the key factors contributing to job satisfaction are (1) engagement, (2) respect, praise and appreciation, (3) having friends at work, and (4) having a good relationship with the boss. By the way, fair compensation counts but rarely tops the list.

We also know that current and former employees are less likely to hire a lawyer and assert a claim if they feel like they have been treated fairly and respectfully and if they feel like they have been told the truth.

"We also know that current and former employees are less likely to hire a lawyer and assert a claim if they feel like they have been treated fairly and respectfully and if they feel like they have been told the truth."

Work is personal. And how we personally feel about work manifests itself in how we do our job, and, significantly, how we treat the patient (customer or client).

The following is an illustrative and non-exhaustive list of conduct that violates this policy: • Making threatening remarks (written or verbal).

• Aggressive or hostile acts such as shouting, using profanity, throwing objects at another person, fighting or intentionally damaging another person's property.

• Bullying, intimidating or harassing another person (for example, sending threatening communication or using threatening body language or gestures, such as standing close to someone or shaking your fist at them).

• Behavior that causes another person emotional distress.

• Assault.

• No form of workplace incivility will be tolerated.

And yet, over and over, we see employment related claims brought against businesses that cannot seem to get out of their own way. Sure, there is the stuff in headlines like sexual harassment, which is simply too prevalent and, thankfully, front and center at last.

2. A complaint procedure. For example:

Behind the headlines is an insidious problem that finds its way into most businesses at some point, and when left unattended, wrecks the culture.

We will directly and thoroughly investigate all complaints of workplace incivility and will take prompt corrective action, including discipline, if appropriate.

Bullying.

Shouting, using profanity, throwing objects, sending threatening communications or using threatening body language or gestures (such as standing close to someone or shaking a finger at them). Making demeaning remarks. The silent treatment. Passive aggressive behavior like keeping someone out of the loop, forgetting to invite, trying to get someone fired or making them quit.

Most healthcare businesses have policies against sexual harassment and discrimination, working while impaired, protecting confidential information, and complying with HIPAA. How about adding a workplace civility policy?

A workplace civility policy should touch on three things: 1. Standards of conduct, behavior expectations, defining what is acceptable and what is not okay. For example:

If you witness or are subjected to any conduct that you believe violates this policy, you must speak to, write to, or otherwise contact the practice manager or a member of the leadership team as soon as possible.

Your communication should be as detailed as possible, including the names of all individuals involved and any witnesses.

3. A promise not to engage in retaliation against someone that complains.

For example: We prohibit any form of discipline, reprisal, intimidation or retaliation for reporting incidents of workplace incivility of any kind, pursuing a complaint or cooperating in related investigations.

We are committed to enforcing this policy against all forms of workplace incivility. However, the effectiveness of these efforts depends largely on reporting. If employees feel that they or someone else may have been subjected to conduct that violates this policy, they should report it immediately. If employees do not report, then we may not become aware of a possible violation of this policy and may not be able to take appropriate corrective action.

Every employee should individually acknowledge receipt, review and understanding of the policy, with a distinct signature and date. The policy is a term and condition of employment.

Continued on page 20.

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Continued from page 19.

At this point, you are probably thinking one of two things: 1. Oh my gosh, we are a small practice, this is not a problem and a policy seems like lawyer overkill.

Fair enough. Hopefully, you are correct. Don’t, however, be like the guy that only flosses his front teeth and thinks the pretty façade somehow means there is no decay further back. Small does not equal no problem. Instead, small often means no place to go so things fester until everyone wonders why great people quit or how they ended up in a lawsuit. Draft a policy that doesn’t feel like lawyer overkill. The advantage of having a policy is that it gives employees explicit permission to call out a problem and the practice explicit permission to address it.

2. Are you kidding me, the bully is one of the dentists and they own the practice. If someone complains nothing will happen – at least nothing good.

When an owner is a bully, it is tough to address. Consider raising the issue as a group. Solidarity can be powerful. Things are pretty much guaranteed not to improve if no one says anything.

An aside. If you are the bully, well, seriously? Why? Insecurity or a power trip?

Get over it. Honestly, what would your mother say? Mine would say, “I did not raise you in a barn” and “If you cannot say something nice, then do not say anything at all.” Do yourself and everyone you work with a favor, try not being a bully and see what happens.

The idea of workplace civility extends beyond our co-workers to guests that join us at work. Patients, the product and pharma reps, the person that keeps the aquarium in good shape, should all be on good behavior and reminded when they forget.

Let’s take stock.

We know that workplace civility contributes to job satisfaction which, in turn, contributes to jobs done well. We know that when people feel like they have been treated fairly and respectfully, they are less likely to lawyer up. All to the good.

It follows that a workplace that tolerates incivility, whatever the form, only leads to bad stuff, like a crummy culture, turnover, poor performance and lawsuits.

You and your co-workers share a common fate – lots of time together day after day. Watch out for each other. Preventing decay is easier, so I have been told every six months for most of my life, than the alternative.

About the Author David Bashford, Esq. is an attorney with the law firm Range, a business law, strategy, communications and policy firm headquartered in Denver. David’s practice focuses on business matters, training and the management side of employment law. He may be reached at davidbashford@range.law.

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September 12 - Rodrigo E. F. Neiva, DDS, MS

Periodontist. Director of the Graduate Program in Periodontics of the University of Florida – College of Dentistry Title: Grafting and Osseodensification

October 10 - Lambert Stumpel, DDS Dentist. San Francisco, California Title: Fixed Hybrid Prosthesis: the cumulative experience of over 500 cases November 14 - Steven D. Nytko, DDS, MS

Periodontist. Kentfield, California Title: A New Era in Soft-Tissue Reconstruction

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FEATURE

MAXIMIZE YOUR TIME AND MONEY A LOOK INTO ACQUIRING PRACTICE FINANCING

By Mark Chatterley

Y

ou are buying a business!

That sounds obvious, but it is often overlooked. You are buying a business first and a dental practice second. You will hear you need to start applying with banks early. Honestly, there is not much a bank can tell you without having a practice to evaluate. The practice dictates everything in the deal, from where you will live to the amount you will make. There is no such thing as a “preapproval” for buying any business without having the business to analyze.

Do I go with the cheapest rate? That sounds like an obvious answer, but it is not an easy question. Your loan will come with several key items to consider: pre-payment penalty, covenants, closing fees and most importantly, quality of customer service. Ask what kind of service will you receive after closing?

If you are not given an actual individual that will help you after, you will have to resort to calling automated 1-800 lines.

Covenants are rarely discussed up front, which means you find them out at closing while reading the loan documents. These are restrictions on what you can and cannot do in your business. All banks have covenants, but some are much better than Are you eligible for a loan? others. A failure in a covenant can cause a technical Here are some quick guidelines to “pre-qualify” "The practice dictates default which can trigger penalties or even rate changes. yourself for practice financing: credit score above everything in the deal, Some covenants require you to send the lender practice 700, no bankruptcy on record, no short sales or financial reports on a regular basis during the term of foreclosures, no excessive student debt and a dental from where you will live the loan. The bank then analyzes your financial reports. license active for a minimum of 12 months (or to the amount you will If you do not meet their calculated profit margins, you commonly, 24 months). Failing any of these categories make." can be considered in technical default. Many covenants does not mean you cannot obtain financing, but it will prevent you from acquiring other practices or incurring prove much more difficult. additional debt without the lender's consent. Make sure you understand these ahead of time.

What type of practice should can I qualify for a loan?

The more debt you owe, the stronger the practice you must buy. If you have Most banks require your full banking relationship. Often, banks do not reasonable but large student loans, you will need to buy a practice that has make much, if any, on the loan so they make up their losses through your strong cash flow. You will not be able to buy a small practice with low-gross banking relationship. Like many things in life, if you buy the cheapest item revenues in hopes it will grow. A bank has to qualify you based on the actual it will save you money initially but may be more frustrating and cost more numbers, not the potential numbers. in the end.

If you have little to no student debt, your options are wide open. The best dental practices to buy can be ones with a retiring doctor who has been You found the practice, now what? working fewer hours, but maintains a strong hygiene program with active Start your application for life and disability insurance right away! Yes, you patients. This type of practice can be purchased for a modest price, yet will likely need both. If the bank does not require both, you should have quickly grow to a high-grossing office. Many times, these practices have to them anyway for the sake of prudence. Life insurance needs to be enough to be updated in equipment and procedures but can be worth the extra effort. cover the loan balance. Disability/Business Overhead or Business Reducing Term (preferred option) insurance needs to be enough to cover monthly Keep in mind your cost of living. If you live in a very expensive area or have payments on the loan. Insurance is typically the most common reason a a large mortgage, this will require you to buy a higher grossing practice transaction must be postponed since it can take a while to finalize. Most which will cost more. banks require the entire policy to be in place before funding.

What can you expect from a banker?

Select a banker who has done dental loans before and is an expert.

Beware, you will find many bankers who claim to be experts but cannot distinguish between an E4D and a Cerec, a cone beam from a pano or what going “digital” actually means. It is important that the banker knows your business. Not knowing the industry can cause delays and cost you money.

Conclusion

Buying a practice is stressful. The first months of owning a practice can be crazy, but having the right professionals around you can make the process an amazing and rewarding experience. Happy hunting.

About the Author Mark Chatterley is a Vice President of Healthcare Finance at Bank of the West.

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FEATURE

HOW TO TAKE ADVANTAGE OF TODAY'S MARKETING TRENDS: AN OLD-FASHIONED APPROACH

By Patrick Chavoustie

O

ften, dentists are overly consumed with being “state of the art” or “trendsetters” when it comes to marketing their dental practice. In my day-today conversations with dentists who are potential clients, we spend much of our time talking about modernday marketing tactics such as websites, social media, SEO, pay per click and reputation management. In today’s market, these types of tactics are extremely important, but nothing beats faceto-face networking. Building your brand one handshake at a time may be “old fashioned,” but it’s also time-tested, proven and all but foolproof. Building networks and being a cornerstone in your community will not only bring in new patients the old-fashioned way, but it will also light up your website traffic and social media accounts. If you want to be popular on Google, be popular in real life. Here are a few ways you can put you and your practice on the path to success.

Sponsor Youth Recreational Sports Teams and Clubs

Sometimes, for as little as a few hundred dollars you can sponsor a local youth rec team. This means your name is on the jersey of eight or more players.

These jerseys are seen by parents of the players, but it doesn’t stop there.

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Extended family and opposing teams’ families will see your branding as well.

You can also increase your reach and branding with signage in brochures and at rec sports facilities. Not only are you getting your name into the local community, your dollars are also going to a worthy cause. It’s a win-win!

Want to take your support to the next level? Volunteer to coach a team! It’s a great way to give back while solidifying your position within the community.

Adopt a Local High School and the Schools that Feed It

High schools are getting huge! My son’s high school has 2,200 students and a staff of over 200. Getting in front of these students can mean getting in front of more than 4,400 parents. There are great options to promote your business at schools on all sorts of levels. Yearbooks, musicals and play programs, sporting events, calendars, dances, proms, school publications, graduations and so many other opportunities are available. You could even look at holding a free teeth-whitening day to show appreciation for teachers and support staff. Perhaps you can attend and set up a sign and table at “Back-to-School” and Parent-Teacher nights or Career Days. Contact your local middle and high schools and ask what events and other options there are to support the school. The possibilities and reach are nearly endless.

Join a Chamber of Commerce

with local business owners. This benefits everyone. For additional reach, ask employers to announce your partnership on their social media sites tagging you and your business, again, extending reach beyond your current social networks.

Joining a Chamber of Commerce is a wonderful way to meet other business owners in the area. This allows you to connect not only with them, but oftentimes several of their employees. Most chambers are relatively low-cost to join, Become a Referral Source for Your Fellow Small depending on the membership level you choose. Joining Business Owners a chamber of commerce can offer endless opportunities If you want to be the go-to referral source, be the go-to " Building your brand to meet people and build long-lasting, mutually beneficial referral source! Make sure to encourage your clients to relationships. Most chambers allow members to offer and one handshake at support your fellow small business owners. Let them promote discount offers to other members, too. Joining a a time may be “old know who to ask for and to remind them that you chamber can also increase your website reach on Google sent them their way. People will never forget someone fashioned,” but it’s also and other search engines by building a link from the who becomes a source of new business for them. Being chamber’s website directory to your website. If you want time-tested, proven and mindful about helping others build their business is a to take it to the next level and maximize this source, all but foolproof." fantastic way to be relevant in building relationships offer to volunteer as an ambassador or look for volunteer within your community. opportunities. Many chambers allow current members to be ambassadors for new chamber members. This allows There are lots of ways to be popular on the internet but one outstanding way to you to create a one-on-one relationship with every new business owner who be popular off the internet. Build a solid marketing plan and include one, or all, joins. Networking actions can equate to a great deal of new clients month after of the above ways to get active in your own backyard; it’s a sure-fire way to be a month. star in your community.

Create a Discount Plan for Local Business Employees

Offering a discount card or plan for the employees of local businesses can really help you stand out in the community. As health and dental plan costs continue to rise for employers, they are often looking for alternative ways to offer and find benefits for their employees. Negotiating special pricing for local employees will drive new patients to your practice while building strong relationships

About the Author Patrick Chavoustie leads the digital marketing team at Omni, a dental website, SEO and marketing firm located in Colorado. When not working hands-on with his clients Patrick enjoys, golf and travel along with spending time with his wife and three teenage sons.

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CLINICAL

MINIMUM PREPARATION = MAXIMUM LONGEVITY

By Mike Malone, DDS, FAGD, AAACD

T

here has been an evolution of dental ceramics from its early

an endosseous implant or an all-ceramic bridge. We also recommended four

use in the late 1800’s to present day. Abraham Weinstein

conservative ceramic veneers for the upper incisors. Also included in her diagnosis

invented the porcelain-fused-to-metal crown in the late

was the obvious lack of attached gingiva on the facial of #25. She elected to wait on

1950’s (DiMatteo). This system was the most dependable

a connective tissue graft until after the restorative procedures. After discussing her

and most widely used tooth-colored restoration for many years.

different restorative options, Samantha chose to proceed with a lithium disilicate

The introduction of bonding ceramics

bridge to replace the missing incisor

to tooth enamel was a game-changer

and lithium disilicate veneers on #7-

in many ways. In 1982, Simonson and

10 as well as #24. Her periodontal

Calamia (2) reported that porcelain

health was good so she elected

etched with hydrofluoric acid could

to start her treatment with KOR

be predictably bonded to tooth

whitening.

enamel with composite resin. The next Clinical and Laboratory

year Calamia reported a system of fabricating facial feldspathic porcelain veneers with a refractory model technique (3). Around the same time

Fig. 1. Samantha was unhappy with her smile.

Procedures Fig. 2. Before retracted view.

whether closing the spaces between

Horn (4) wrote an article describing a technique for making

her incisors would make her teeth look too big or too long.

porcelain veneers with platinum foil.

We used our computer smile imaging program (Patient Gallery) to show her how she would look with the changes

Leucite-reinforced ceramics were introduced in the 1990’s

we would accomplish with her veneers (Fig. 3). It’s important

(Empress, Ivoclar Vivadent). With the introduction of these

to reassure the patient by explaining how we will make our

pressed restorations using the lost wax technique, the strength

changes with the provisional restorations and give them all

of the porcelain went from 90 megapascals to approximately

the time they need to evaluate their speech and looks before

150 megapascals. The pressing technique also improved

we proceed with the final veneers. Another set of alginate

the fit of the all-ceramic restorations. E.max pressable and

impressions were taken and the models were mounted with

millable ceramics (lithium disilicate) were introduced by Ivoclar Vivadent in 2006. The strength of the e.max ceramic is 360-500 megapascals. E-max also became available in many

Samantha was very concerned about

the original CR bite. The models and a detailed prescription Fig. 3. Digital smile design using imaging software from Patient Gallery.

different shades and three different opacities.

were sent to Trinident Dental Laboratory for the waxup. The original models were returned from the lab with detailed duplicate stone models of the waxup. These models were used

to make templates to fabricate the Radica temporaries.

CASE REPORT Diagnosis and Treatment Planning Samantha was presented to our office with two major concerns: (1) She was very unhappy with the removable partial denture replacing her lower right lateral incisor. (2) She did not like the small upper incisors with chips and spaces (Fig. 1 & 2). At the initial consultation we determined that she was a potential candidate for adhesive dentistry and she was scheduled to return for a comprehensive examination followed by a review of findings and a final plan of treatment.

Before making the appointment for veneer preparations, Samantha underwent the KOR whitening process. After two weeks of tray whitening, she came in for office power whitening. She was very happy with the results, so we appointed her for her preparation phase.

Samantha was premedicated with 2 milligrams of lorazepam one hour before her preparation appointment. Her upper anteriors were anesthetized with 2 carpules of articaine 4% with 1:100,000 epinephrine. The rubber dam was placed from cuspid to cuspid to isolate the area and retract the lips and cheeks. The four

When Samantha returned, she received a complete periodontal and comprehensive dental exam followed by a complete series of digital radiographs, diagnostic casts mounted in centric relation and digital photographs. At her review appointment we discussed several options, including replacing the missing incisor with either

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maxillary teeth were minimally prepared for veneers (Fig. 4 & 5). The lingual margins were carried all the way to the lingual to allow complete closure of the spaces. Enamel was left on the surface of all teeth as much as possible to facilitate adhesion. Radiosurgery (Ellman) was used to allow the margins to be prepared

subgingivally in the interproximal

restorations were fabricated using

areas to prevent black triangles.

Snapstone models from the bonding

A clear matrix was created with a

hydrocolloid impressions. The three

positive pressure thermoforming

Van R hydrocolloid impressions

unit (Mini-Star). This matrix was

were poured with die stone for the

then used to make sure there was

final restorations. The temporary

adequate reduction for the final

restorations were made indirectly

restorations. The rubber dam was

with

removed and final impressions

templates made on models of the

Fig. 4. Veneer preparation #7-10.

Radica

shade

i2

using

were made with hydrocolloid (Van

waxup using Copyplast and Biocryl

R/Pentron) and Identic Syringable

thermoforming sheets.

Bonding Hydrocolloid (DUX Dental/Kerr).

When

complete

the

Radica

spot

bonded

The lower anterior region was then anesthetized by infiltrating one carpule

provisionals

of articaine from #24-27. The rubber dam was then placed and #24 was

on the prepared teeth etching a

conservatively prepared for a veneer and #25 and f#27 were minimally prepared for full crown bridge abutments (Fig. 5). All margins were left in enamel and all

Fig. 5. Preparations complete. Conservative preps leaving enamel on most surfaces.

were

small 1-2 mm spot of enamel and cementing with Insure YRL. All

of the lingual surfaces and some of the facial surfaces also had remaining enamel

were placed except for #8. Another

to assist in adhesion. The exposed root surface on #25 was purposely left intact so

bonding hydrocolloid impression was taken to make trial veneers for #8.The final

she could have a connective tissue graft procedure after the restorative phase. The

temporary was then cemented.

soft tissue on the ridge was shaped with radiosurgery for an ovate pontic to insure that the pontic will be cleanable and without food traps. The preps were checked

After checking the occlusion, another alginate impression was taken of the

for reduction with the clear reduction matrix and multiple impressions were taken

maxillary arch for fabrication of an Essix appliance to serve as a temporary night

with two types of hydrocolloid impression material just like the maxillary arch.

guard. This appliance also doubles as an emergency retainer that can be placed

While Samantha napped in our recovery room massage chair, her temporary

over a loose or dislodged temporary until the patient can come in during regular

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25

hours for recementation. Samantha was

as the “hold back” model since it stays in

then given an appointment to return

the office and is not used by the lab. The

in one week to evaluate the provisional

patient is not appointed until the doctor

restorations and to try in the “trial veneer.”

has confirmed that all restorations fit all three models ideally and the case matches

Two full-arch models of the upper and

the prototype (temporary) restorations.

lower arches were sent to Trinident

At this point the patient is scheduled for

Laboratory, along with the trial unit model.

This model was used to fabricate two trial units, using e.max HT BL1 for the first

Fig. 6. Patient’s completed smile with the Radica provisional veneers and bridge.

what will confidently be the final insertion

Fig. 7. Samantha returned in one week to evaluate her provisionals.

appointment, as the shape, shade and fit has been confirmed.

and e.max HT BL2 for the second. When Samantha returned one week later, she was

The patient is not sedated for the final

concerned that the incisors were too long.

placement of the restorations. The upper

We shortened all four slightly and gave her

arch is numbed, provisionals removed and

another week to evaluate the shape and

excess cement removed. All veneers are

length. When she returned she was happy

tried in dry to confirm fit and contacts, then

with the provisional restorations as they

replaced with try-in gel to get the patient’s

were (Fig. 6, 7, & 8). We took an alginate impression of the approved provisionals, as well as close up, smile and facial digital

approval. Once the patient approves and Fig. 8. Close-up view of Radica provisionals.

Fig. 9. #8 trial veneer placed with try in gel.

images. At that same appointment, we

signs an approval form she can then be sedated if she wants. Samantha felt she did not need sedation for this final procedure.

carefully removed the #8 provisional and

The teeth were cleaned thoroughly with a

tried the two trial veneers on the prepped tooth with yellow red light Insure try-in gel.

Prep Start (Danville) air abrasion unit set at low (30-35 lbs) pressure. The rubber dam

The HT BL2 seemed to be a perfect match (Fig. 9). After taking several images, we

was then placed and the veneers bonded with Liner Bond 2V, PhotoBond (Kuraray), and

replaced the provisional veneer.

Insure YRL Veneer Cement (Cosmedent) (Fig. 12). The lower arch was completed in the same manner.

To insure the fit and occlusion of the final restorations are ideal, the trimmed and pinned models are mounted in the dental office by the dental assistant. The model of the

The occlusion was perfected and all adjusted surfaces polished with diamond polishing

approved provisionals are also mounted on the same

points (Komet). A maxillary acrylic night guard was

Artex articulator. These models can be transferred

fabricated directly on the upper arch using Interra

to a similar Artex articulator at Trinident Lab with

(Dentsply). Samantha was appointed to return in two

ideal accuracy. Before being sent to the lab, the case

weeks for a final check and photographs.

is checked by the doctor and the final prescription is Closing Comments

written by the doctor. The final case sent to the lab includes mounted pinned models, solid prep models,

Predictable

mounted model of the approved provisionals, digital

with

adhesive

cosmetic

restorations can be readily achieved by following a

photos of the provisionals, preps and face and the final

system that allows each step to be completed before

detailed prescription.

moving to the next. The most important first step is to listen to the patient when they describe their

Using the mounted model of the approved provisionals as a guide the ceramist can fabricate the

Fig. 10. Layed e.max restorations on the model.

final restorations with predictability. The ceramist used an e.max HT BL2 ingot for the pressing to full contour. The ceramist then cut back the facial slightly to add layering ceramic to give the restorations a beautiful and lifelike look (Fig. 10).

When the case was returned to the doctor’s office it was inspected to insure it matched the provisionals as instructed. Each restoration was then tried on a third model, which was retained in the patient’s case pan in the office (Fig. 11). This model is referred to

26

results

I

1st Quarter 2019 mddsdentist.com

desired goals. Then pre-planning the treatment with proper smile design and an excellent waxup is critical to success. Taking multiple impressions to check and recheck the fit before seating each case is another

important step that virtually eliminates remakes.

Another important change in all ceramic adhesive dentistry is the use of lithium disilicate (e.max) which has up to four times the strength of a feldspathic porcelain restoration.

Even with conservative preparation a lithium disilicate 3-unit bridge has enough strength to replace anterior teeth predictably. In addition, lithium disilicate veneers when used properly are just as esthetic as any other ceramic system (Fig. 13 & 14). Samantha’s

goals for having a more esthetic smile and replacing the missing tooth were achieved with minimum preparation using the e.max ceramic system (Fig. 15 & 16)).

Acknowledgement The author wishes to thank Gayle Vanderwall with Trinident Laboratory in Metairie, LA for her exceptional skill in the completion of the technical phase of this case. Also thanks to

Fig. 11. Each restoration was tried on the “hold back” F model before appointing the patient for insertion.

Fig. 12. E.max veneers after bonding with Insureyellow-red light resin veneer cement.

Fig. 13. One week post op view. Layered lithium disilicate veneers and lower 3-unit bridge.

Fig. 14. Close-up of Samantha’s e.max smile.

Fig. 15. Before full face view.

Fig. 16. Samantha with her new e.max smile.

Dentistry Today for permission to reprint this article, first published in January 2017.

About the Author Mike Malone, DDS maintains a full-time dental practice limited to cosmetic and reconstructive dentistry in Lafayette, LA and is an Assistant Clinical Professor in prosthodontics at the LSU School of Dentistry. He has been a member of the American Academy of Cosmetic Dentistry since 1988 and was accredited in 1992.

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1st Quarter 2019 mddsdentist.com

27

TRIPARTITE NEWS

Empowering Members to Succeed

By Greg Hill, JD, CAE

I

recall several years ago at a national association meeting, a speaker making the statement, “Without our members, we are nothing.” These six words form the framework for a fundamental belief I have always held that our members are the focus of everything we do. As an association, our purpose is to empower our members to succeed.

CDA Enterprises, Inc., the for-profit subsidiary of the Colorado Dental Association (CDA), is part of our broad strategy to help our members better serve the oral health needs of the patients of Colorado.

For a number of years, the CDA has provided a line "Without our members, of endorsed products to its members – credit card we are nothing.” processing through Best Card, These six words form insurance products through the framework for a COPIC and malpractice fundamental belief I liability coverage through the Dentists Professional Liability have always held that Trust. We also partnered our members are the with the American Dental focus of everything Association’s for-profit, ADA Member Advantage, and we do." brought you products like an affinity credit card through US Bank and patient financing through CareCredit, among others. These companies provide an exclusive discount to CDA members and through these savings, membership can often pay for itself. We’ve researched and vetted multiple dental-related companies, so you don’t have to, and negotiated prices exclusively for members. For example, Best Card saves the average dental practice 23%, or $2,366 annually over prior processors, all while providing unparalleled customer service.

As you may know, CDA Enterprises, Inc. has relaunched and is prepared to play a much larger and important role in providing support for the marketing of our endorsed companies. We’re also working to provide you with salable products and services like Prescription Lab Pads and the new X-Ray Training Program, now available as a subscription service on our website.

Along with the endorsed companies designed to save you money, the CDA is also launching a line of exclusive member benefits – programs only available to CDA members. These include the CDA Retirement Solution and the Dentists Professional Liability Trust. The CDA Retirement Solution is a product that allows you to offer a retirement plan to your employees while aiming to reduce your administrative burden,

I

28 1st Quarter 2019 mddsdentist.com

transferring fiduciary risks and potentially reducing costs. Sponsoring and maintaining a retirement plan can be challenging. The CDA Retirement Solution brings together a team of professionals on your behalf so you can focus on running your business, not your retirement plan.

The Dentists Professional Liability Trust is now part of these exclusive member benefits since they provide coverage only to CDA members.

The Trust was created by Colorado dentists for Colorado dentists and is still managed by a board of directors comprised of Colorado dentists (and members of the CDA). The Trust is administered locally, allowing members a rapid, knowledgeable response to any threat of legal action or patient complaint.

We believe that combining the member savings through the endorsed line of products and the unique professional services our members (and only our members) receive through the Exclusive Member Benefit Programs, we are bringing incredible, tangible value to members.

But wait, there’s more! In the next few weeks, we will announce a new CDA program for members that will provide you the on-demand experience you expect from your association in the 21st century. We are also considering other exclusive programs to bring to our members later this year. Stay tuned.

By putting our members first, the CDA is committed to empowering the success of all our members. By fostering a community that helps dentists focus on their passion of providing patients with the best level of care, we are helping ensure superior oral health in our state.

To learn more about all the endorsed companies offered through the CDA and CDA Enterprises and our exclusive member benefits, visit our website at www.cdaonline.org.

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

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1st Quarter 2019 mddsdentist.com

29

Did You Know?

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

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

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

EVENT CALENDAR APRIL April 4 New Member Welcome Event Blue Moon Brewery RiNo 3750 Chestnut Place Denver, CO 80216 6:00pm – 8:00pm (303) 488-9700 April 7 MDDS and CDA's Ladies in the Loupe Present: High Tea at the Brown Palace The Brown Palace 321 17th St., Denver, CO 80202 11:00am – 2:00pm (303) 488-9700 April 12 Botulinum Toxin (Xeomin, Dysport, Botox) and Dermal Fillers Training, Level I -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700 April 13 Botulinum Toxin (Xeomin, Dysport, Botox) and Dermal Fillers Training, Levels II & III -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700

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30 1st Quarter 2019 mddsdentist.com

April 13 Frontline TMJ, Headaches and Orofacial Pain Level I -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700 April 17 CPR & AED Training -American Life Safety Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700

MAY May 4 Navigating the World of 3D Imaging - Dr. Miriam Robins and Mr. Jim Pienkowski Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 3:00pm (303) 488-9700

May 17 Oral Surgery Techniques for Predictably Great Outcomes -Dr. John Alonge Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 3:00pm (303) 488-9700 May 31-June 1 Dental Sleep Principles: Where the Rubber Meets the Road -Drs. Terry Bennett and Chase Bennett Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700

JUNE June 1 MDDS Summer Kickoff Event Colorado Rapids Soccer Game Dick’s Sporting Goods Park 6000 Victory Way Commerce City, CO 80022 (303) 488-9700

KEEP UP-TO-DATE EVERYTHING MDDS

Follow us @ mddsdentist today!

CLASSIFIEDS Jobs GP Associate needed in Fort Collins - A successful GP practice in Fort Collins has an immediate opening for an Associate Dentist. The previous associate produced $450K on 2 days per week without doing RCT. Beautiful location, large modern office. Traditional family practice, privately owned. Lots of flexibility for the right candidate. Contact me a ddsdoc970@gmail.com.

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If you’re ready to take your career to the next level and gain valuable experience, apply today!The average income for a PDS-supported Owner Dentist, whose practice has been open at least two years, is $390,000.

Contact Linda Ryan at ryanl@pacden.com 303-902-2693

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GP for Sale: North Eastern CO (CO 1735) 4 Ops, approx. 600K in collections, Stand-alone bldg. sold w/ practice. Dr. retiring, 303-759- 8425, www.adsprecise.com, frontdesk@adsprecise.com Associate to Buy-In 50% of Practice in Denver (CO 1806) 3 OPS, 900K in collections. For more information, please call 303.759.8425 or email frontdesk@adsprecise.com OMS practice, western mountains near Vail and Aspen, (CO 1350) Annual Revenues $840K, 3 ops, 1260 sq ft. email: frontdesk@adsprecise.com, 303-759-8425.

Summer Dentist Needed - Come work for a well established single doctor practice that values long term patient relationships over all other considerations. If you like establishing rapport with patients while offering top-notch care this is the place for you. Tues – Th 8-5 and Fri 8-2 with one Sat per month 8-5.

Competitive pay, PTO, LTD and paid holidays. Please e-mail CV to moreheadpeakdental@gmail.com and put hygienist in the subject line.

GP in Boulder (CO 1815) Dr. relocating out of state, Collections $600K, 5 OPS. email: frontdesk@ adsprecise.com 303-759-8425

Experienced Dental Assistant - Wanted experienced Dental Assistant. We are non-corporate Prosthodontic office with two locations in Denver. We have an immediate need for a chairside assistant with Implant experience. We are open Monday through Wednesday 8-5 and Thursdays 7-2:30. Our benefits include health insurance, 401(k), paid vacation, and performance bonuses. Mandatory qualifications include: prior experience as a dental assistant; experience with dental implants; great organizational skills; ability to multitask; experience with Dentrix and Dexis; x-ray certifications; run and positive attitude that works well with team members; and strong work ethic. Interested Candidates please email your cover letter and resume to bridgecreekdentistry@hotmail.com.

Perio Practice for Sale: (CO 1723) Denver Suburbs South. Reduced Price - now $295K- Annual Rev. $530K, 4 ops/2 equipped, beautiful office – 1,964 sq ft. Dr. Retiring. 303-759-8425, www.adsprecise.com, frontdesk@adsprecise.com

Dental Assistant - There’s nothing more rewarding than working beside amazing people, doing amazing things together. We know because we live it every single day. If you want to learn more about finding your tribe of amazing people, send us your resume. We are looking for an excellent individual with great fundamental clinical skills and at least two years of clinical experience. We are a private dental practice that offers advanced, personalized dentistry. If you love learning and growing and being part of something bigger than yourself, we would like to get to know you. Send resumes to dr.levos@levosdentistry.com.

Dental Assistant - Excellent opportunity for an energetic, outgoing, proactive candidate to join our busy Highlands Ranch pediatric family. Our stable long-term team is dedicated to building relationships with our patients as well as their parents. Willingness to grow professionally and personality is preferred over dental experience. Contact Kim Preece at (303) 865-4066 or kim@SierkChildrensDentistry.com with questions or to submit a resume.

GP and free-standing building (sold with practice) for Sale: West Colorado Springs (CO 1803) Dr retiring, annual revenue $275K, 5 OPS. For information please call 303.759.8425 or email frontdesk@adsprecise.com

GP for Sale: South East CO (CO 1625) Revs $880K, 6 Ops, 1,700sf, Dr. Retiring. 50% interest in 10K sq ft bldg. sold w/practice. 303-759-8425, www.adsprecise.com, frontdesk@adsprecise.com GP for Sale: Southern Colorado (CO 1738) Dr. retiring, annual revenue $325K, 5 OPS. For information please call 303.759.8425 or email frontdesk@adsprecise.com GP Practice: Pueblo (CO 1808). Doctor retiring. Annual revenue $300,000. 3 ops. Contact frontdesk@ adsprecise.com or 303-759-8425 Highlands Ranch Start-Up Practice for Sale: (CO 1723) $295K, Annual Rev. $530K, 4 ops/2 equipped, high-end finished office in desirable neighborhood- 1,964 sq ft. Dr. Retiring. 303-759-8425, www.adsprecise. com, frontdesk@adsprecise.com.

For Sale CATscan Vatech Ewoo - Takes Great CATS and Panorexs. Also can convert CAT to Pan. Will pay for calibration included in the price. 12″ field or less. Will deliver from Denver. Won’t last long. Only $21,000 OBO. Contact DrNeilD@comcast.net and 720-543-8384 for more details.

Real Estate Endodontics Practice for sale in Southern Colorado (CO 1819) $600K+ net income after debt service, 3 Ops, 2 fully equipped, Dr. retiring. Sale Price: $920K. For information, email: frontdesk@adsprecise.com or call 303-759-8425.

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3rd Quarter 2017 mddsdentist.com

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1st Quarter 2019 mddsdentist.com

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