Articulator Volume 22, Issue 5

ARTICULATOR MDDS Connections for Metro Denver’s Dental Profession

2nd Quarter, 2018 Volume 22, Issue 5

WHAT THE TECH? pg.12

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THE 5 GREATEST CYBER THREATS TO YOUR PRACTICE & HOW TO PREVENT THEM

18 EVOLUTION THROUGH TECHNOLOGY TOOTH SENSORS 22 USING TO DETECT DISEASE ASPECTS OF 24 BIOLOGIC DIGITAL DENTISTRY

B

Healthy patients and a healthy business.

At Commerce Bank, we have the experience to manage the unique financial challenges of the dental industry. From simple loan plans that help patients to optimizing your most complex payment processes, we have options that allow you to focus on providing a higher level of dental care.

303-214-5430 commercebank.com Š 2018 Commerce Bancshares, Inc.

2nd quarter 2018

what's inside?

8

p.

8 The 5 Greatest Cyber Threats to

Your Practice & How to Prevent Them

pg.22

12 A Silver Lining in Dentistry 14 Owning Your Office Space:

Four Types of Property to Consider

Advertisers Directory

18 Evolution Through Technology 20 Investing in Practice Growth With Equipment & Technology

ADS Precise Transitions adsprecise.com................................. 21

Denver Implant Study Club https://disc.events/............................ 28

Berkley Risk Services of Colorado colorado.berkleyrisk.com...................... 5

Healthcare Medical Waste Services, LLC hcmws.com....................................... 29

22 Using Tooth Sensors to Detect Disease

Carr Healthcare Realty carrhr.com........................... Back Cover

24 Biologic Aspects of Digital Dentistry

Commerce Bank commercebank.com/dentistry....Inside Front Cover

28 Electronic Curb Appeal: Does Your

Copic Financial Services Group copicfsg.com..................................... 15

Practice Need a Renovation?

departments 4 President's Letter

CTC Associates ctc-associates.com/............................ 29 Dentists Professional Liability Trust of Colorado tdplt.com.......................................... 13 Dental Lifeline Network dentallifeline.org............................... 23

Kickstart Dental Marketing kickstartdental.com............................ 21 New Horizons Dental Lab http://denturesonimplants.com........... 26 Northwestern Mutual shawncopeland.nm.com.................... 11 SAS Transitions sastransitions.com............................... 5 Vitality Laboratories vitalitydentalarts.com.................... 16-17

6 Reflections 7 Member Spotlight 10 Member Matters

Co-Editors Amisha Singh, DDS; Allen Vean, DMD Creative Manager CT Nelson Director of Marketing & Communications & Managing Editor Cara Stan MDDS Standing Officers

26 Tripartite News

President Nicholas Chiovitti, DDS President-Elect Brian Gurinsky, DDS, MS

27 The Relentless Dentist 30 Event Calendar 31 Classifieds

Treasurer Nelle Barr, DMD Secretary Kevin Patterson, DDS, MD

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

Stay True

MDDS ANNOUNCES

By Nicholas Chiovitti, DDS

S

ummer is fast approaching, and I have just over a month left in my term as MDDS President.

The business of the Society is in great hands with incoming president Dr. Brian Gurinsky taking

the helm in July. Shelly Fava being selected as Executive Director after heading up the Rocky Mountain Dental

Convention (RMDC) and the Society’s continuing education is a bonus for 2018. The MDDS staff has the stability to serve your needs.

"I want to personally thank everyone that gave of themselves through the year."

Our committees are strong with a diverse group of members to ensure your benefits remain strong. We are a financially sound organization and I am proud to say that your MDDS

dues will remain unchanged for the 2018 – 2019 fiscal year.

I am proud of all we have been able to accomplish this year. Some of the tangible benefits to members include: - Improved facilities at the Mountain West Dental Institute (MWDI).

Including upgraded audio visual and better security and increase in the continuing education speaker budget.

- Increased community outreach and access to care through a partnership with Kids in Need of Dentistry (KIND) patient parents in the MWDI clinic.

- More low cost continuing education at MWDI - New website and server to allow easier navigation and access to benefits.

- Career Center - New member welcome events that are open to all members.

- An improved RMDC experience with great speakers – all included in your membership!

The strength of our Society is based on the openness and volunteerism of our members. I want to personally thank everyone that gave of themselves through the year. Whether it is in your own office, attending charity events like Colorado Mission of Mercy (COMOM) or Freedom Day or volunteering to serve on the committees for MDDS. We are the envy of the country because our members make it so.

How do we stay strong in an ever-changing market? It’s easy! Stay true to your mission statement, always listen and act from your heart. You cannot fail if you follow those simple rules.

Thank you for allowing me to serve your dental society. It has truly been an honor.

4

NO DUES INCREASE FOR 2019!

You work hard for your money and should keep it! As fellow dentists, the MDDS Board of Directors is pleased to announce there will be no increase for the MDDS portion of your tripartite dues in 2019.

Have questions about your membership or how to access your benefits?

Call MDDS at (303) 488-9700 or visit mddsdentist.com.

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2nd Quarter 2018 mddsdentist.com

5

REFLECTIONS

How the Seasons Change – A Reflection on Work Life Balance

By Amisha Singh, DDS

I

wear two hats. I love both my hats dearly. The one of

that needs to be written or some PnL that needs to be reviewed.

motherhood is worn in and faded. It feels like jeans, washed a hundred times, like a second skin, comfort and home and

So how do I, type-A personality extraordinaire, perfectionist to the max, survive

happiness. That hat is sometimes covered in peas and carrots

this failure? I train myself to make failure feel comfortable. It is a horrid exercise,

and often has crayon demarcations of handsome princes

painful, uncomfortable and hard. But it is also necessary. The founders of The

riding horses under a nostalgic stick and circle sun, drawn on

Skimm, my favorite start-up and my favorite news source, have a tradition in their

with tiny hands still learning their way in the world. The hat of the professional

company… they celebrate failure. They believe that if you are not failing, at least a little, you are not trying hard enough. So their new year

woman in me is cleaned and pressed, sharp lines and perfection; it is woven with threads of doing well by doing good for the world, of leaving the profession and our planet a little better than I found it.

The problem is both of the hats refuse to fit at the same time. The mom hat gets carrot goop on the professional hat. The professional hat pokes my kiddos when I give hugs with its sharp, prestigious corners. I used to think I could snip a little here, and add a little there and somehow Frankenstein out a hat which I could wear all the time, the

"MDDS’s community is my support system, the way in which I find my tribe and learn how I get to wear both of my beloved hats concurrently, beautifully, completely."

resolution was to “fail faster and harder,” and I have since been pursuing exercises in failing faster and harder myself.

These exercises do what life has thus been unable to so far: they make failing feel natural and less absolute. They allow me to think in terms of “seasons.”

In life, every human goes through seasons. If you are single and focusing on building your empire, you may not go out on many dates. That is okay, because you are currently living in a “season” of growth and personal

best pieces of both genres. I now realized this is impossible.

development. For me, when I met my husband back in

If I changed either hat, it would not be complete.

2009, I was hustling, applying to medical schools and on a one way road headed right towards my ideal career. And then, fate intervened.

I read Shonda Rhime’s “Year of Yes” about a year ago (Grey’s Anatomy marathons

I met the love of my life and got married. My “season,” and thus my definition of

carry no shame, people). I actually had an obscenely long commute and listened

an “ideal career” consequently changed. I hit pause, took a gap year, planned a

to it on audiobook. Day in, day out I would sit outside my office at the time trying

wedding and reconstructed what work life balance looked like for me. While I

to get a few more words in. Shonda talked so candidly about a subject that I

was in dental school, again I was in a “season“ of focusing on my career which

grappled with on a daily basis: Having It All. Her words hit home so hard that I

would mean missed Valentine dates (which my darling husband took in stride)

was reaching for tissues on E470 while driving home.

and late nights in Sim lab. But when I got pregnant with my oldest son, literally with the appearance of a second pink line, another season set in. It was a season

“How do you do it all? The answer is this: I don’t. Whenever you see me somewhere

of focusing on health, happiness and calm. It was a season of applying 100% of

succeeding in one area of my life, that almost certainly means that I am failing in

my effort and energy into being a stable and warm home for my growing child.

another area of my life. That is the trade off.” – Shonda Rhimes, Year of Yes

So crowns that would not seat or patients who would not show, sheer calamities previously, became small hurdles.

We are told repeatedly as little girls that Having It All is the dream. It is the vision.

6

It is the expectation. But it is also impossible. When you peek into my life from

Ask yourself, what is your current season? What are your current goals? As the

outside windows, you may think that, indeed, I finally Have It All. I succeeded. I

seasons change outside of the window letting sun in while I write this, I feel my

made it. Box checked, mission accomplished. I lecture and I write and I speak and

season changing too. I am learning how to identify my success with my current

I am a dentist and I mentor and essentially “conquer the world” while still being

goals and this is subsequently changing my life. It is the only way I know how to

a mom. I make Halloween costumes and go on field trips and make pancakes

balance work and life. Your hats may not look like mine. Your seasons may not

with whipped cream smiley faces. But every moment of success in one realm

have the same challenges as mine. But the world you have dedicated your life to is

is a moment of failure in another. Every one of my moments of success is also

my world. You are my community. We tried with this issue to help you tackle your

a moment in which the other part of me is failing. If I am lecturing to dental

problems and to provide solutions for you, no matter your season, no matter your

students in Orlando, I am missing bedtime and stories with the kids who ask

goals. MDDS’s community is my support system, the way in which I find my tribe

Grandma where Mommy went… again. If I am at home, building forts in our

and learn how I get to wear both of my beloved hats concurrently, beautifully,

living room and bringing the wrath of the Tickle Monster, I am avoiding a blog

completely. We are here for you in all of your seasons.

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2nd Quarter 2018 mddsdentist.com

MEMBER SPOTLIGHT

Ellen Sachs, DDS, MS

Endodontist, Cherry Creek Endodontics Denver, CO What new piece of dental technology are you most excited about?

"The J Morita CBCT (Cone Beam Computed Tomography) machine!

Aside from the microscope, rotary file systems and digital radiography, the application of the CBCT to endodontics has changed the way I practice. After learning to read a CBCT scan and actually seeing the tooth and surrounding structures in 3D, I will not practice without it."

What do you wish the public understood about dentistry?

"Most dental procedures are relatively inexpensive compared to most other medical procedures. Oral health can What do you think affect one’s overall health and is the dental industry’s should be considered just as biggest opportunity? important to maintain as the rest of the body."

"To help educate and provide a means to treat the general population to maintain a healthy dentition throughout one’s lifetime. Dental practitioners are more knowledgeable about oral health than any What would you other medical professional. We have the be doing if you were not ability to help and educate so many more in dentistry? people in this world than those who actually seek our help."

"I would have been a stay at home mom, designing and sewing bathing suits. I am a mom and I still design and sew bathing suits, so I have the best of both worlds!"

What is the best advice

you ever received?

"My mom told me from a very young age that money does not bring you happiness. “If you don’t have your health, you don’t have anything! All the money in the world doesn’t matter!"

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2nd Quarter 2018 mddsdentist.com

77

FEATURED ARTICLE

THE 5 GREATEST CYBER THREATS TO YOUR PRACTICE & HOW TO PREVENT THEM

By Ben Bidmead & Cody Martin, Sequoia Cyber Solutions

W

hile cybersecurity is still a new topic to many organizations, healthcare remains the number one targeted industry by cyber-criminals. Today’s advanced persistent threats are more sophisticated than ever, but some fixes can be implemented immediately, significantly increasing your organization’s security posture overnight.

The 5 Greatest Cyber Threats: 1.

2.

3.

4.

5.

Weak Passwords Phishing Attacks No Network Segmentation No Clean Desk Policy No Security Posture Awareness

PASSWORD POLICY Passwords are your keys to accessing every application of importance.

They are used on social media, medical software, ATMs and smart phone.

Security threats have escalated exponentially as our society has become more interconnected. The content stored in these platforms is more valuable to attackers than you might think. Compromised accounts can be leveraged to reveal sensitive information such as banking, credit card or other account information which can be further exploited or sold on the Dark Web (think eBay for criminals). Data breaches are sometimes followed by ransom demands, regulatory fines, a decline in company reputation and in 50% of cases among small and medium businesses, bankruptcy.

Ok, you get that passwords are important. So how do we address it? First, never

8

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2nd Quarter 2018 mddsdentist.com

reuse passwords. The average person can’t remember multiple, completely unique passwords. A password manager is a useful tool which randomly generates long, secure passwords and saves them automatically.

Let’s look at these two password examples: Tr0ub4dor&3 correct-horse-stable-battery Which one do you think is more secure? At first glance, one might think the first example is more secure because it uses multiple types of characters.

However, this is predictable behavior to a seasoned hacker. The longer the password, the stronger the password. The second example is a phrase that can be quickly generated, easily remembered and difficult to crack. To make it even stronger, simply add an extra word to the end of the passphrase.

PHISHING ATTACKS Ransomware continues to pose a terrifying threat to healthcare practices. In the spring of 2017, the WannaCry outbreak wreaked havoc on hundreds of thousands of machines across the globe. Total damage costs were estimated at $8 billion.

Ransomware viruses are almost always executed when an unsuspecting user clicks on a compromised link inside a phishing email. Phishing attacks have become very sophisticated in recent years and are successful because they use social engineering techniques to elicit an emotional response from the target.

Hackers will use personal information obtained from past data breaches to make the email more believable to the user. In some cases, phishing emails

disguise themselves as coming from an email account whom the target knows.

This tactic is very effective because one is more inclined to perform the requested action when they think they recognize the sender.

Regular user education and training can help identify potential threats and prevent a disastrous data breach. These training modules educate your last line of defense, the users, and help them identify the different between legitimate emails and sophisticated phishing attempts.

NETWORK SEGMENTATION The act of splitting a network into multiple subnetworks (subnets) is referred to as network segmentation. Two primary advantages of proper network segmentation are increased network security and performance.

A segmented network has fewer hosts (IP addresses) per subnet, which minimizes local network traffic and reduces congestion, leading to increased performance.

Security is improved because broadcasts will be contained within the local virtual network.

A sound security practice is segmenting your network into multiple subnets, with varying security requirements, and enforcing policies on what can move from subnet to subnet.

Proper segmentation is typically achieved by a combination of firewalls and VLANs (Virtual Local Area Networks), essentially quarantining traffic within their relegated domains.

A network security audit performed to ensure effective network segmentation practices are being followed is recommended. A common issue that comes up in these audits is improper segmentation between guest and internal wireless networks. Even if the wireless SSIDs are broken out into guest/employee privileges, critical business files and sensitive information are still easily accessed from the guest wireless network. Organizations should ensure that critical workstations, servers, medical equipment and Point of Sale systems are segmented from guest user access. It is common for machines on these networks are running out-of-date software which is vulnerable to exploitation.

CLEAN DESK POLICY A Clean Desk Policy refers to the corporate directive which clearly outlines how each employee should leave their desk or workstation whenever they step away from their controlled environment. These policies focus on information security and can vary from organization to organization. Not writing down passwords on notepads, keeping patient data out of sight and securely inaccessible when not in use, and not leaving documents containing sensitive information in the printer are just a few simple, albeit obvious, practices which can decrease your risk of a data breach.

WHAT IS SECURITY POSTURE? Security Posture is a scale by which an organization’s likelihood of a security breach is measured. A surprisingly large number of organizations have no idea how and where their networks are vulnerable to attack. The value of sensitive information and customer data is constantly increasing, so attacks will continue to be more advanced and persistent.

The quickest way for an organization to confirm their existing security posture is to have a vulnerability assessment performed. A vulnerability assessment is an automated process which scans a network or web application against over 20,000 common vulnerabilities and exposures (CVE). Upon completion and analysis of the scan, a detailed report is provided outlining the organization’s security posture; information about the vulnerabilities discovered and all necessary remediation strategies. Many times, especially with initial tests, critical flaws are discovered. Ninety-seven of all data breaches are caused

by CVEs. This means that for almost every data breach you have ever heard about, a security patch existed before the company was breached!

There is no magic product, application or vendor that can protect organizations from all the sophisticated threats coming at us every day. The best you can do is take as many steps as possible to limit the potential damage. Today’s threat landscape is so vast, it can be quite overwhelming to even know where to begin, sometimes leading to “paralysis by analysis.”

About the Author Ben Bidmead, Senior Security Architect, brings many years of cybersecurity defense, penetration testing, programming, administration, and a solid background with a wide range of server-side technologies and applications, including web development. Ben is a Fortinet Network Security Expert 3, Qualys+ certified and when not kicking butt on behalf of Sequoia and its partners, enjoys driving his car and competing in security CTF (capture the flag) events and contests.

Cody Martin, VP of Sales for Sequoia has spent his 15+ year career in both channel sales and end-user client facing roles. Cody has been happily married for eight years and is an avid golfer who enjoys traveling, cooking, reading and laughing.

Sources: 1. acronis.com/en-us/articles/costs-of-ransomware-attacks/

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MEMBERMATTERS MATTERS MEMBER

February New Member Welcome Event - The Hornet

Dentists, students and sponsors were able to connect on South Broadway.

St. Patrick's Day Parade– MDDS Access to Care Float

New Members, Welcome!

Dr. Alan Baughman Dr. Roger Castro Dr. Christopher Cotterill Dr. Maharshi Desai Dr. Ronald Dorsey Dr. Timothy Hart Dr. Michael Hong Dr. Dale Kim Dr. Rosa Le Dr. Zoulfia Magaril Dr. Kamyab Mohager Dr. Eugenio Montecinos Dr. Christopher Morris Dr. Liza De Petrillo Dr. Dominic Philpott Dr. Spencer Schneider Dr. Ross Schwartz Dr. Buhm Sohn Dr. Rita Taylor Dr. Steven Tran Dr. Andrew Vorona Dr. Daniel Ward Dr. Song Yang Dr. Ethan Yoo Dr. Lucinda Young

MDDS takes on LoDo! Volunteers handed out oral health supplies and got the crowd excited about dentistry.

More than 65 volunteers joined MDDS on a sunny Saturday for the annual Access to Care float in the Denver St. Patrick’s Day Parade.

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10 2nd Quarter 2018 mddsdentist.com

April New Member Welcome Event Interstate Bar & Grill

New MDDS members gathered in the Santa Fe Art District for cocktails, hors d’oeuvres and conversation.

CU Signing Day

4th year students at the CU School of Dental Medicine gathered at MDDS for their annual didactic day and signed up for tripartite membership.

Kids In Need of Dentistry (KIND)

MDDS hosted more than 100 partners of KIND for a morning breakfast meeting and clinic tour.

KIND staff and volunteers held a free clinic day for patients and their parents at MWDI.

CREATING A

RELIABLE INCOME IN RETIREMENT

Research validates that an integrated approach helps provide a more efficient and predictable income in retirement than an investments only strategy.

To understand how this research fits into the asset of your practice, please contact:

Shawn W Copeland, CLTC Financial Advisor 303.996.2385 • shawn.copeland@nm.com www.shawncopeland.com

Proud Sponsor of

Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company, Milwaukee, WI (NM) (life and disability insurance, annuities and life insurance with long-term care benefits) and its subsidiaries. Shawn W Copeland is an Insurance Agent of NM. Registered Representative of Northwestern Mutual Investment Services, LLC (securities), a subsidiary of NM, broker-dealer, registered investment adviser, and member FINRA and SIPC. Representative of Northwestern Mutual Wealth Management Company®, Milwaukee, WI (fiduciary and fee-based financial planning services), a subsidiary of NM and federal savings bank.

11

CLINICAL

A SILVER LINING IN DENTISTRY

By Heather Jenkins, DDS & Anne R. Wilson, DDS, MS

S

ilver Diamine Fluoride (SDF) and other silver topical products have been used outside the U.S. for more than 40 years as caries-arresting agents.1 Medical use of silver has been noted as early as 4,000 B.C. The ancient Egyptians, Greeks, Romans and Phoenicians used silver to preserve food and water; this practice continued through World War II. Silver nitrate has been used to treat ulcers, burn injuries, fistulas, fractures and wounds. The topical application aided in healing due to its antibacterial properties.2

SDF can be an adjunct to the dental armamentarium. Advantages include the arrest of caries without the need for local anesthesia, complex restorative procedures and lengthy appointments. The use of SDF may ease the minds of patients that have dental fears or are too young to tolerate treatment in a traditional dental setting. When approaching a young pre-cooperative patient, treatment options for caries have included glass ionomer sedative fillings, sedation or general anesthesia. Interim treatment with glass ionomer until cooperation improves presents unique challenges while sedation "Studies have indicated or general anesthesia involves the ionic silver has an more complex and invasive care – circumvention or delay of treatment antibacterial effect when may be possible if SDF is utilized. infiltrating dentinal Beyond the pediatric population, geriatric patients and those with tubules." compromised health conditions may be optimal candidates for SDF to reduce the need for invasive, complex or lengthy restorative procedures including extraction of teeth from root caries.

In 2016, the Food and Drug Administration approved use of SDF as a toothdesensitizing agent and Class II medical device with off-label use for arresting caries. The commercially available SDF product is a 38 percent diamine fluoride in a clear or tinted liquid, with a pH of 10. Each application contains 0.2 mg of fluoride3, which is well below the probable toxic dose of 5 mg/kg.4 One drop of SDF is 9.5 mg and can treat five teeth with a maximum dose of 9.5mg per 10kg of patient weight. Compared to sodium fluoride varnish with 22,600 ppm, SDF contains 44,800 ppm. Unlike fluoride varnish, SDF is not a preventive regimen for patients and is aimed at arresting dental caries. There are numerous theories regarding the precise mechanism of SDF. Studies have indicated the ionic silver has an antibacterial effect when infiltrating dentinal tubules.1 Calcium fluoride reacts with hydroxyapatite to form fluorohydroxyapatite, a less soluble byproduct when compared to hydroxyapatite, further strengthening tooth structure.5 Although there is much discussion among dentists since the FDA approved SDF, careful assessment of the indications and contraindications should occur with each patient. Silver diamine fluoride should not be used for patients with an allergy to silver, teeth with pulpal necrosis, irreversible pulpitis or large carious lesions approximating the pulp.6, 7 Tissue irritation may occur with SDF, thus delayed treatment should be considered if oral ulcerative lesions are present. While SDF

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12 2nd Quarter 2018 mddsdentist.com

may seem to be the ideal treatment, one major challenge is the permanent black discoloration of carious tooth structure. Patients or parents with a high concern for esthetics may be hesitant to choose SDF. Other potential concerns include the need for reapplication, lack of caries arrest in teeth with extensive carious lesions and the impact on future restorative materials. Nonetheless, in recent studies, the bond strength of composite resin restorations was not compromised in teeth previously treated with SDF.8 Clinical studies are being conducted, yet currently, there are no specific recommendations for follow-up and reapplication. In some studies, SDF has been applied to lesions every six months to coincide with regular dental visits.9 Alternatively, some clinicians apply once a week for three weeks for initial treatment, then monitor at routine appointments with reapplication if lesions are not arrested.

Silver diamine fluoride is a viable treatment option if indicated. Patient selection and careful assessment of each patient is necessary. We should keep in mind there is no “magic solution” for the treatment of caries since this complex process has been well documented as multifactorial. Silver diamine fluoride should not be used alone, but should be used in conjunction with caries risk assessment, diet, oral hygiene and anticipatory guidance.

References

1. American Academy of Pediatric Dentistry. Policy on the use of silver diamine fluoride for pediatric dental patients. Pediatr Dent. 2017;39(6):51-53.

2. Alexander JW. History of the medical use of silver. Surg Infect (Larchmt). 2009;10(3):289-92.

3. Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentine caries. J Dent Res. 2002;81(11):767-70.

4. Whitford GM. Fluoride in dental products: safety considerations. J Dent Res. 1987;66(5):1056-60.

5. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Diammine silver fluoride and its clinical application. J Osaka Univ Dent Sch. 1972;12:1-20.

6. Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc. 2016;44(1):16-28.

7. American Academy of Pediatric Dentistry. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent. 2017;39(6):146-55.

8. Quock RL, Barros JA, Yang SW, Patel SA Effect of silver diamine fluoride on microtensile bond strength to dentin. Oper Dent. 2012:37(6):610-6.

9. Zhi QH, Lo EC, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine cares in preschool children. J Dent. 2012;40(11):962-7.

About the Authors Dr. Heather Jenkins is an Assistant Professor at the University of Colorado School of Dental Medicine in Aurora, CO. Her background has been in providing dental care for underserved communities in New Mexico and Colorado. While treating patients with limited access to care, her interest in the use of Diamine Fluoride in susceptible populations has increased.

Dr. Anne R Wilson is a Clinical Professor at the University of Colorado School of Dental Medicine in Aurora, CO and serves as Predoctoral Director in Pediatric Dentistry. She has served as Chair of the Oral Clinical Examination Subcommittee for the American Board of Pediatric Dentistry and serves on the Scientific Affairs Committee of the AAPD and Editorial Board for Pediatric Dentistry and reviews for several peer-reviewed journals including the International Journal of Paediatric Dentistry, Journal of Dental Education, Pediatric Dentistry, and Journal of Public Health Dentistry.

Take a Closer Look

0

$

.00

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 1st Quarter 2018 I mddsdentist.com www.tdplt.com

13

OWNING YOUR OFFICE SPACE: FOUR TYPES OF PROPERTY TO CONSIDER

By Colin Carr, CEO Carr Healthcare Realty

M

any healthcare professionals desire to own their office space. There are several reasons why: paying down principal and building equity with every payment, appreciation, additional tax benefits, not dealing with landlord negotiations every few years and more.

In many cities across the country, the number one factor in choosing the best property type for your practice is inventory and availability, seconded by cost.

Additionally, your personal preference and quality of care you provide may not be represented in each property type or area. This can eliminate several or all remaining options. However, assuming you have a full slate of options to choose from, let’s look at the four main types of property that make the most sense for healthcare professionals: Stand-Alone Buildings Stand-alone buildings are defined as being the location of one owner/tenant.

They typically offer excellent natural light and windows in all four directions.

They provide signage that is not competing with other businesses sharing the same location and help practices stand out from the crowd. These buildings can be tucked away inside business parks or on a major thoroughfare with high traffic counts and visibility. Overall, stand-alone buildings can help create and strengthen a practice’s identity and are a very desirable asset.

Office Condos Office condos are an excellent option for individuals who want to own office space but do not need a large building or have concerns about property management responsibilities. It can be very challenging to make the economics

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work when building smaller properties. Unlike building residential houses, the fees and costs of developing commercial real estate make it cost prohibitive to build structures that are only a few thousand feet. This results in fewer available stand-alone buildings under 5,000 SF. Whether the property was originally built as an office condo or was later converted, these allow users to purchase smaller sized spaces that best fit their requirements. Another benefit is that the majority are professionally managed.

Smaller, stand-alone properties can make the expense of professional management more challenging as the cost can be disproportionate for just one owner. However, when you have larger properties that are divided into smaller units as condos, spreading out the cost of hiring a property manager becomes much more reasonable. Property managers direct the vendors that are required to keep a property running at its highest level, including: landscaping, exterior maintenance, fire and security monitoring, snow removal, insurance, janitorial and more.

Multi-Tenant Buildings Many people are curious about the opportunity to own a building where they occupy one space but also have other tenants who help pay the operating costs and mortgage. While this approach can be desirable, it can also be very risky and expensive. Simply put, if tenants are in place and paying their rent, money is often available to offset the cost of owning and can create an additional income stream. However, you must also consider the alternatives. What happens when a tenant is not paying their rent and you need to evict them? Or what if a space goes vacant and it takes months or a year (or more!) to lease?

Having a vacant commercial space typically costs thousands of dollars per month. Taxes, insurance and common area maintenance are charged on the

PRACTICE MANAGEMENT entire building, not just your space. Depending on the size of the vacancy, this can really add up. When a space is vacant, you are not only forgoing rent on that space but, as the owner, still pay the proportionate amount of operating expenses. Meaning, a single vacancy that takes a year to lease could easily chew up several years of profit.

You also need to make sure you have enough time and energy to complete your project. The average commercial construction project takes 18+ months from start to finish. Twelve months is lightning fast and unrealistic in most jurisdictions due to zoning and required hearing meetings. Twenty-four months can easily become the timeframe if you don’t have the best vendors on your team, or jurisdiction issues. Ground-up construction often gets you the nicest property with the features you desire but be prepared to spend the most money and time on this transaction.

Lastly, most leases require free rent, improvement allowances, attorney and broker fees to complete. A commercial lease can easily cost $100,000 or much more; which means having substantial liquid reserves is mandatory if you want to be a commercial landlord. Multi"Owning real estate tenant buildings provide a very legitimate upside but also can be an excellent a steep downside if the market corrects or your spaces go vacant. Only play this game if you truly have reserves and investment and can are able to support the property whether the additional result in an asset that spaces are leased or not.

While there are additional property types available, such as buying a larger building with multiple parties, these are the four main options for healthcare professionals. Owning real estate can be an excellent investment and can result in an asset that is worth even more than your practice. To maximize your success and profitability through real estate, its important to understand all your available is worth even more property options their associated pros and cons. You should always Ground-Up Construction (Buying Land and Developing perform a detailed purchase vs. lease comparison to ensure you than your practice."

Your Own Building) fully understand the economics prior to making a decision. Start the The exact property you are looking for is often not available process by hiring a qualified tenant/buyer broker who is trained to and starting from scratch may be your only option. In certain dense or urban represent healthcare professionals and can assist with creating a strategic plan to markets, there might not be any vacant land available and your only choice is make the most of your next purchase. to buy an existing building, scrape it and start over.

About the Author Colin Carr is the founder of Carr Healthcare Realty, the nation’s leading provider of Ground-up construction offers the ability to build the exact size building you commercial real estate services for healthcare tenants and buyers. desire with the design and features you choose; subject to code or covenant restrictions. Having full control of all options is a huge benefit. This typically comes with the highest cost as well. New construction is more expensive than existing buildings in most scenarios.

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FEATURED ARTICLE

EVOLUTION THROUGH TECHNOLOGY

By Joseph N. Datar, DDS, MSD

D

entistry is an ever evolving profession. Our choices of materials, techniques, and instrumentation seem to expand daily. The variety in size, scope and type of practices is growing as well. Today, there are limitless possibilities in how we are able to practice our profession.

However, one foundational principal in dentistry is common for us all. That is the belief that we are life-long students, the idea that our development as health-care providers is never over. We have an obligation to complete continuing education in order to grow our knowledge base and stay abreast of the latest developments in all disciplines of dentistry. That requirement is ultimately intended to improve our ability to plan and deliver the highest quality of care possible for our patients.

Our development as providers isn’t limited to the growth of our knowledge base alone. We are fortunate to be practicing in a time where dental technology is growing at a rapid pace. Digital radiography, practice management software, and electronic health records are just a few examples of dental innovations that have revolutionized our profession. I believe that integration of technology into our practices helps distinguish us from our peers, accelerates the growth of our practices and makes us better clinicians. I’d like to share two examples of how modern technology has improved my practice and the quality of care I am able to deliver to my patients.

CBCT As a periodontist, I use cone beam computed tomography (CBCT) primarily for assessment and planning of dental implants. Determination of the bony volume of a potential implant site with CBCT is an important advantage over traditional 2-dimensional images. However, equally important is the ability to accurately elucidate key anatomic structures (the inferior alveolar nerve, maxillary sinuses, lingual undercuts of the posterior mandible, etc.). CBCT is important in helping determine where we can place dental implants, but it is just as useful in determining where we can’t place dental implants. In 2012, the American Academy of Oral and Maxillofacial Radiology published a position paper stating that assessment of ALL potential dental implant sites should include cross-sectional imaging. The method of choice for that assessment is CBCT1.

I place a great value on communication and collaboration with my restorative partners. Ultimately, my job is to provide a service to them, as well as our patients, that will maximize treatment outcomes. Their involvement during the planning process helps me practice in accordance with a principle made popular in Stephen Covey’s The 7 Habits of Highly Effective People: Begin With The End In Mind. Implant dentistry, from single-unit to full-arch protheses, should be restoratively driven. Surgeons are limited by the available bone, certain anatomic structures discussed earlier and space considerations. But, ultimately, the surgical side of implant dentistry is about providing the foundation of an anatomically and functionally exceptional restoration. Collaboration between a surgeon and restorative provider, in the planning process, is vital toward achieving that goal.

CBCT is tremendous communication tool in facilitating that process. My restorative partners and I often use CBCT images to plan implants that are surgically and restoratively driven. Because CBCT files (Digital Imaging and Communications in Medicine, DICOM) are digital, they are easily transferred through HIPAA-

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compliant means and viewed on many devices. Incorporation of a good lab into the digital workflow allows us to utilize guided implant surgery, which is extremely valuable in areas with limited space or anatomic restrictions.

CBCT has also improved my communication with patients. This has been perhaps the most surprising benefit of this diagnostic tool. We are all visual learners and our patients are no different. By being able to show them their planned implant site, an alveolar ridge width deficiency, or pneumatized maxillary sinus, patients feel more involved in the treatment planning process. Ultimately, that empowerment leads to greater patient trust in a clinician, better engagement during treatment planning and greater case acceptance. CBCT has provided me a powerful way to connect with my patients and include them in my diagnostic process.

My practice has the 3D Accuitomo 170 by J. Morita. With a wide range of fields of view, we are able to focus our exposure to a single implant site or expand to the entire dentition Figure 1. Coronal view of tooth including both TMJs. I am very #12 revealing a fracture of the palatal root fortunate to work with Dr. Debra Gander, a board certified Oral and Maxillofacial Radiologist, in my practice. We strongly adhere to the ALARA (As Low As Reasonable Achievable) principle and the flexibility of this unit facilitates that by minimizing patient exposure while producing high quality images.

The information provided by CBCT is tremendously useful outside of implant dentistry as well. Determining the location and orientation of impacted teeth, airway analysis, and insight into alveolar bone volume for Periodontally Accelerated Osteogenic Orthodontics (PAOO, or “Wilckodontics”) proves valuable to orthodontists. Evaluation of 3rd molars is important for myself and oral surgeons. Assessment of suspicious lesions is crucial to all disciplines. I have been surprised at the number of endodontic lesions discovered, particularly resorptive lesions, missed or underfilled canals, and root fractures (Figure 1) that often aren’t discernable with 2-dimensional images. CBCT fosters my relationship with not only my patients and restorative partners, but also other specialists. It is a versatile tool that I utilize every day.

Perioscopy Another important piece of technology that is vital to my practice is the perioscope. The perioscope is a minimally invasive dental endoscope that allows visualization of subgingival tooth and implant surfaces. Through an illuminated fiber optic endoscope, the perioscope is able to display typically inaccessible areas at a magnification of up to 48x on a 17-inch medical grade monitor (Figure 2). It uses anatomically designed explorers (“shield” in Figure 2) to place the scope at the desired subgingival location. They are site-specific, similar to Gracey curettes.

This aids in the diagnosis and treatment of periodontal and peri-implant diseases.

regeneration around implants with use of the perioscope alone (Figure 3).

Excess cement around veneers and crowns on teeth can be just as harmful.

The perioscope offers a minimally-invasive tool to remove it and resolve gingival inflammation around those restorations without having to surgically reflect a flap.

Much like the leap from 2-dimensional imaging to CBCT, we are now able to better visualize structures and lesions that were inaccessible in the recent past. By utilizing a tool that allows subgingival visualization, we are more able to detect root fractures, subgingival caries, external root resorption and endodontic perforations. Like CBCT imaging, perioscopy allows me to become more involved with my restorative colleagues and other specialists by providing this information.

Figure 2. View of a 6mm pocket displayed on the perioscope

A primary objective of periodontal therapy is the removal of deposits and biofilm from diseased root surfaces. This is initially achieved non-surgically with scaling and root planing (SRP). Although SRP has a long track record of success, it is also highly ineffective at actually removing subgingival calculus deposits. In fact, periodontal literature has shown that up to 57.7% of surfaces treated with traditional scaling and root planing are left with residual calculus2. This is primarily due to our lack of visibility and dependence solely on our tactile perception when performing the procedure. Regardless of the ability of the hygienist or dentist, there is room for improvement in the quality of the SRP we deliver. Using the perioscope, significantly less residual calculus is left on root surfaces after SRP, particularly in deeper pockets3. Simply, visualization of the root or implant surface during debridement allows more effective removal of deposits. By offering more effective removal of calculus and biofilm, we often are able to forgo the need for surgical periodontal therapy. As a minimally invasive therapy, our patients have less post-therapy discomfort and root sensitivity.

With the growing use of dental implants, complications associated with placement and restoration of implants also increases. Despite our best efforts, residual cement around implant restorations is an inevitable outcome in many cases. In a 2009 study, 81% of implants with signs of periimplant disease were associated with excess cement4. Unfortunately, residual cement can lead to inflammation of the peri-implant gingiva and eventual bone loss much like calculus around natural teeth. By Figure 3. 1-year follow up (right) of a failing using the perioscope, we implant treated with perioscopy alone are able to confirm the presence of and remove subgingival cement around implant restorations. This early intervention is vital in preventing larger complications associated with persistent periimplant inflammation. We have even seen radiographic evidence of bone

Like any piece of technology, the perioscope has its limitations. I do not recommend it for every case that walks into my office. I’ll usually reserve its use for mild to moderate periodontitis and early peri-implant mucositis or implantitis cases. This decision is primarily determined by the anticipated depth of access within the diseased pockets. Traditional periodontal surgery (gingival flap procedures, osseous resection, guided tissue regeneration, etc.) still has its place. Although perioscopy can avoid the post-operative discomfort and root sensitivity that most patients dread with periodontal surgery, I view it as one of many tools in my armamentarium. What excites me most about this technology is that it simply improves upon established techniques that achieve the fundamental objective of periodontal therapy, removal of biofilm.

You’ve read over 1,500 words of me gushing over two pieces of technology that are vital in my office. I can write another 10,000 words describing how valuable technology is to my patients, colleagues, and practice. If you take one thing from this article, it should be technology SUPPLEMENTS our patient assessment, treatment planning and delivery of care. There is no substitute for good fundamental dentistry. I know plenty of practitioners with “low-tech” practices who deliver excellent care. Remember, integration of technology into our daily practice does not define who we are as clinicians but enhances it. Our job is to utilize the resources available to us and continue to evolve.

About the Author Dr. Joseph Datar, a Colorado native, is a board-certified periodontist who owns a private practice in the Denver Tech Center. In his private practice, The Fauchard Center, Dr. Datar focuses on collaboration with his patients and restorative partners while providing periodontal, dental implant and IV sedation services. Along with his wife, Marisa, he enjoys the outdoors with their rescue dog, Kemba.

References 1. Tyndall, Donald A., et al. "Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography." Oral surgery, oral medicine, oral pathology and oral radiology 113.6 (2012): 817826.

2. Sherman, P. R., et al. "The effectiveness of subgingival scaling and root planing I. Clinical detection of residual calculus." Journal of periodontology 61.1 (1990): 3-8.

3. Geisinger, Maria L., et al. "The effectiveness of subgingival scaling and root planing: an evaluation of therapy with and without the use of the periodontal endoscope." Journal of periodontology 78.1 (2007): 22-28.

4. Wilson Jr, Thomas G. "The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study." Journal of periodontology 80.9 (2009): 1388-1392.

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FEATURED ARTICLE

INVESTING IN PRACTICE GROWTH WITH EQUIPMENT & TECHNOLOGY

By Kent Murphy, Senior Business Development Manager, Wells Fargo Practice Finance

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growth potential.

nvesting in your practice with equipment and technology upgrades is one of many ways to grow your business. By expanding services, you are poised to not only provide benefits to your practice, but also to patient care. Yes, that's right - benefits to patient care. That alone may be the best reason to upgrade equipment and technology. While there are no rules for exactly how much investment might increase your bottom line, investing done right can increase your practice’s

When considering an upgrade to your practice, begin by asking yourself: Will production increase, increasing cash flow?

Productivity has the potential to increase significantly with integrated computer systems that link to your insurance companies. This allows for immediate access to patient charts and billing data, connects operatories with the front desk, provides patient education and deliver patient emails. New laser equipment and digital technologies may also save valuable time at each chair.

Will the upgrade improve daily work life for me and my team?

You may find that you enjoy your practice considerably more after integrating new high-technology systems. Your new system can enhance teamwork and make dental care easier, not only for the patient but for the doctor and staff. Team members often feel proud of the high level of services the practice provides, contributing to a sense of enthusiasm in learning and practicing new techniques. This can lead to overall increased employee morale.

And, perhaps most importantly, Will the purchase improve patient care?

Much of today’s dental technology is focused on delivering more effective oral care using less invasive procedures. With enhanced equipment now available for early detection of tooth decay, treatment of cavities, periodontal diseases and cleanings, patients experience significantly greater comfort. Advanced technologies also create more convenience for patients to maintain their oral health, meaning less chair time and fewer repeat visits.

So how do you know if it is the right time to invest?

Decisions about upgrading your equipment and technology are among the most important you will make as a practice owner. The financial investment can be substantial, and logistics must be carefully planned. To successfully formulate your next steps, analyze the opportunity. Two classic tools for this are the Strengths, Weakness, Opportunity, Threats (SWOT) Analysis and the Weighted Pro/Con ranking worksheet. Both of these resources are available online. Next, consult with your advisors (tax advisor, attorney, lender, etc.) and share your findings. You may see things in a whole new light, impacting your timing and investment.

patient and team satisfaction is hard to measure, but you will see it in smiles every day!

You might even have time to implement that marketing plan you created when you opened the practice.

Consult your tax advisor when making an investment as they should be able to help you outline a comfortable technology investment program that keeps your practice current and competitive. Tax laws change, so keep this advisor close when making purchases to ensure your return accurately reflects your investments. To help ensure a smooth implementation of your program, you might consider working with a lender that specializes in dental practice financing and understands your particular business needs.

Once you have a plan, your lender will help you determine whether your project is financially feasible. Expect to provide two years of personal and practice tax returns, a current profit and loss statement and your preliminary plan. Credit decisions for practice financing are typically based on an assessment of a practice’s cash flow and your ability to repay your loan with enough left over to cover you livelihood and other expenses. A credit evaluation can vary depending upon the lender you choose. Generally speaking, however, low debt yields higher credit limit decisions and high debt results in lower credit decisions.

Another reason to have a plan is simply to keep up with the competition. With new doctors coming out of school possibly having worked on the most up to date equipment, you might find yourself faced with a high-tech neighbor.

Investing in advanced technology demonstrates an important first impression to your patients. …you take their oral health seriously, are up to date with current techniques and have the knowledge to deal with their individual dental needs.

"Your new system can enhance teamwork and make dental care easier, not only for the patient but for the doctor and staff."

And, don’t forget your practice team. Advanced equipment and technology may make their workday easier, but it also involves change to their environment. Don’t assume they are all on board. Include them in the process early on. Discuss your thoughts and reasons for change. Listen to their concerns. Remember everyone will need to be trained, so allow for different learning styles and be prepared for some resistance. In the end, if you have done your homework, listened to their concerns, and communicated your vision and goals, the team should understand how a little disruption can make a wonderful change for the better. Take time to celebrate and recognize your team for their efforts during the change. Celebrating can build synergy and momentum within the office.

But the decision does not end with one purchase or investment. Dental technology is advancing every year, with new materials, equipment and software being introduced continually. For that reason, purchasing advanced technology may not be a one-time investment. To stay at the forefront of the industry, consider developing a technology and equipment upgrade plan that allows for investment on a schedule you create.

With everything you need to consider and still keep your practice running, it is important to take time and do your homework. Working with your trusted advisors is a first step to potential success. So if it’s at all feasible for your practice, it may be a good time to start

Setting meaningful goals for productivity improvements to offset your technology investment is another way to evaluate and plan for upgrades. For instance, track how long it currently takes each practice function impacted by your technology plan to occur today – from billing and sending out appointment reminders to setting hygiene appointments and specialty procedures. How many additional patients can you see if the team had extra time? What services can you perform in-house that you previously outsourced?

By answering questions like these, you can begin to see how your investment costs may translate for you, your team, and your patients. Decreasing chair time and increasing

About the Author Kent Murphy is the Business Development Manager for Wells Fargo Practice Finance in Colorado, New Mexico and Texas. Kent helps doctors successfully transition into an ownership role, by providing not only financing solutions, but also leveraging his experience in the healthcare market to help ensure a smooth and successful transition.

He enjoys speaking doctors at all stages of their careers and with students to introduce the nation’s next great clinicians to important business concepts and speakers.

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investing in some of today’s advanced technology.

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FEATURED ARTICLE

USING TOOTH SENSORS TO DETECT DISEASE Collaborative research team developing biological sensors that would analyze saliva and send information electronically to doctors

By Erika Ebsworth-Goold

A

n interdisciplinary team of researchers from

Right now, one of the project’s biggest challenges is chemistry.

Washington University School of Medicine in St. Louis and the School of Engineering & Applied

“You only have a finite number of of bio-recognition elements conjugated to

Science is redefining the notion of a wisdom tooth.

the transducer if you are using an antibody that is specific to these peptides,” said Srikanth Singamaneni, associate professor of mechanical engineering &

The team is developing a smart-tooth technology that could someday be used to

materials science. “They get saturated fairly quickly. The question is how do you

detect early signs of certain diseases in high-risk patients by analyzing saliva or

refresh those sensors? That’s one of the aspects we are working to address with

gingival crevicular fluid.

this project.”

“Salivary-based biosensors have generated a lot of interest because of their

The research team says developing a new, minimally invasive system that can

potential for wide applications in medicine,” said Erica Lynn Scheller, who

detect and monitor gum disease and the effectiveness of treatment would be

trained as a dentist and is now an assistant professor of medicine and of cell

beneficial to the 64 million U.S. residents with periodontal disease and to their

biology and physiology in the School of Medicine. “We’re initially working to

dentists. The researchers also are interested in developing other applications for

develop a biological sensor that measures specific peptides active in periodontal

the technology that, while likely years away, could go well beyond the dentist’s

disease and that would be used in combination with a wireless device to retrieve

chair.

that data.”

“We’re developing this sensing platform that can be expanded to include “It’s like an electronic tooth,” said Shantanu Chakrabartty, professor of electrical

additional tracking for inflammatory markers, stress markers and diabetes

& systems engineering in the School of Engineering & Applied Science and a

monitoring,” Scheller said. “Really, anything you can think of that you’d want

partner on the project, currently funded by a four-year, $1.5 million grant from

to track in the oral cavity, we’re developing both the platform and the specific

the National Institutes of Health.

application.”

That electronic tooth is actually a tiny sensor and an electronic chip, about a

This article is reprinted from Washington University in St. Louis’s The Source

few millimeters-cube in volume. It is designed to be inserted inside the patient’s

from April 19, 2018.

gum line or as part of a dental appliance and contains bio-recognition elements that measure disease-specific peptides, which are natural or synthetic groups of amino acids. As a first attempt, the research team will work toward monitoring peptides related to bone breakdown during periodontitis, a dental disease that can lead to loosening and loss of teeth. A wireless ultrasound device would then be used to read the peptide levels and connect to the medical data-cloud.

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About the Author Erika Ebsworth-Goold is executive director of strategic initiatives at Washington University in St. Louis. She served as the publicist for the St. Louis Symphony. Before that, Mrs. Ebsworth-Goold was a television newscast producer in markets including Richmond, Baton Rouge, Denver and ultimately St. Louis.

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FEATURED ARTICLE

BIOLOGIC ASPECTS OF DIGITAL DENTISTRY

By Bernhard Egger, MDT, BDT

T

hese are fast-paced times; changes seem to occur almost every day. In dentistry and dental technology, new methods of treatment and innovative techniques are always being discussed. Questions like, “Do I really need this?” “Should I invest here?” and “Will this be a lasting innovation” or “Will it already be replaced by another one tomorrow?” are top of mind.

For example, computer-aided manufacture of full-ceramic restorations have taken technological leaps and high-performance ceramic materials have entered the market in the past few years. Yet, the same question is still being asked, “Are these systems adequately perfected, practically tested and proven, economically justifiable and future-safe?”

Where is Digital Dentistry? Intraoral Scanner The basis for prosthetic work in dentistry has traditionally been an intraoral impression that was then poured in dental stone. This traditional workflow has proven itself in clinical practice, though impression materials are prone to dimensional changes and stone model expansion. According to Millennium Research Group (MRG), the global dental CAD/CAM system market will grow strongly to reach a value of more than $540 million by 2018.

This market will see particularly strong growth in its chairside segment.

The chairside segment, which permits dentists to have CAD/CAM functionality in their offices, will show the most significant growth worldwide. From around 50 percent of this market in 2010, chairside systems and intraoral scanners will hold nearly 60 percent of a much larger market by 2018. Due to the demand from dentists for chairside systems, a number of new competitors entered the market through 2016, which lead to greater competition and a downward pressure on selling prices. The low penetration of CAD/CAM technology in dental offices leaves significant room for growth, promising substantial revenue gains. In the US, for example, several scanner manufacturers will capitalize on dentists’ interest in replacing traditional impression-taking methods with digital techniques.

The marketing of these intraoral scanners will dramatically expand the market.

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Where Are We Now? Digital Smile Design Digital Smile Design The innovative diagnostic method changes treatment planning phases and increases patient acceptance as they can participate in smile design by previewing their post-treatment smile. Dentists are challenged to improve the smiles of patients who present a multitude of variations in facial, labial and dental characteristics. To best ascertain a treatment plan that will restore a smile to its ideal form for individuals, the principles of smile design are evaluated independently and together.

Patients present their own personal goals for their teeth and facial esthetics, as well as their dental concerns, making proper treatment planning even more challenging. The prosthetic implications of smile design principles are numerous and vary depending on each situation. Techniques can be implemented to reduce the risk of unexpected outcomes. If more time is spent by the dentist on analysis of smile principles during treatment planning, the risk of encountering unexpected outcomes are minimized.

Virtual Articulation for the Analysis of Occlusion The virtual articulator has been designed for the exhaustive analysis of static and dynamic occlusion. This tool incorporates virtual reality applications into dentistry with the purpose of replacing mechanical articulators, thereby avoiding their errors and limitations.

In daily practice, mechanical articulators are used to diagnose and simulate the functional effects of malocclusions and morphological alterations upon dental occlusion. However, this mechanical scenario is very different from the real life biological setting as it poses a series of problems. The movements reproduced by the mechanical articulator follow the margins of structures that conform the mechanical joint, which remain invariable over time, and cannot simulate masticatory movements dependent upon the muscle patterns and resilience of the soft tissues and joint disc. Moreover, tooth mobility cannot be simulated by plaster models. As a result, the latter are unable to reproduce the real life dynamic conditions of occlusion. Additionally, there are other problems derived from the procedures and materials used for assembling the models in the articulator - precision in orienting the model, expansion and

contraction of the plaster, deformation of the bite-recording material, the stability of the articulator, etc.

The virtual articulator offers the possibility of significantly reducing the limitations of mechanical articulators, due to a series of advantages: full analysis can be made of static and dynamic occlusion, of intermaxillary relationships and joint conditions thanks to dynamic visualization in 3D of the mandible, the maxilla or both, and to the possibility of selecting section planes allowing detailed observation of regions of interest such as the temporomandibular joint. Combined with CAD/CAM technology, this tool offers great potential in planning dental implants, since it affords greater precision and a lesser duration of treatment.

Digital TMD Appliance Revolutionary Technology

Splint Design Customized software is used to design the splints. First, the opening is adjusted to an appropriate setting. A CR bite record at the desired opening should be taken to avoid having to change the opening.

Contact points are then defined by clicking on the 3D model surface.

Software automatically relocates the points to ideal positions. For cases with relatively normal curves of Spee, contact points are optimized based on the contact model's occlusal plane.

As contact points are defined, a smooth plane is passed through them to form the main functional contact surface of the splint. Centric relation splints are designed with anterior and cuspid ramps that provide gentle posterior disclusion when the patient protrudes or moves laterally. The length and angle of each ramp is independently controlled.

The width of horizontal shelves adjacent to the ramps can also be specified.

After almost 50 years, acrylic occlusal splints have now gone digital. The digital process for designing and producing flat Fabrication plane and centric relation occlusal The designed splint is saved splints is on its way. The process as a 3D file which is imported provides precise and consistent into CAM software. The splint control over articulation and model is then covered with design parameters. Current the appropriate splint material laboratory methods for which is milled-down to the producing splints utilize a final splint surface with an variety of articulation and accuracy of less than 0.001in. manual trimming methods. The As each light ray isreflected back onthe sensor, the The high-speed machining functional or contact surface is the distance betweenthe projected ray and reflected ray ismeasured. Because the process produces a perfectly result of a technician's subjective fixed angle between theprojector andsensor is known,the distance to the smooth contact surface which object can becalculated throughPythagorastheorem, as one side and one determination of smoothness and does not undergo any additional angle(the fixed angle) ofthe triangle are nowknown. the absence of tooth impressions. finishing.

This essentially guarantees the same splint will never be made Important Features twice for the same case, even by the same technician.

An important feature of digital splints is the smoothness of the contact surface. While conventionally produced splints have indexing The process can be considered in four main steps: impressions that can inhibit the free movement needed to deprogram 1) Model scanning muscles, digital splints are completely smooth.

2) Articulation 3) Design Digital splints can be produced from all materials commonly used to 4) Fabrication make splints, including: cold-cure acrylic, thermoform able materials, hard/soft materials, heat-softening acrylics and light-cure materials.

Model Scanning The arc of closure used to design the splint influences the location of Upper and lower stone models are laser scanned to produce a 3D initial contacts. model in a computer.

Articulation Mounted and unmounted cases can be processed. Mounted cases are articulated digitally by modeling commercial articulators in software.

About the Author Mr. Bernhard Egger, MDT, BDT is a European Dental Association (EDA) certified Specialist. Mr. Egger is the General Manager of Natural Esthetics, Germany. He is a Board Member of the OBI Foundation.

Anticipated improvements to the system include the use of published articulation values related to race, age and sex. In all cases, condylar inclination, eminence curves and the Bennet angle are under software control which provides highly accurate design of the ramps needed for centric relation splints.

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TRIPARTITE NEWS

EMPOWERING MEMBER DENTISTS

By Greg Hill, JD, CAE

T

he Colorado Dental Association (CDA) works to empower its member dentists to build thriving practices and careers. That guiding principle applies not only to the direct practice of dentistry, but to building success for our members in other aspects of their businesses, including their retirement plans.

To provide a better retirement plan option for member dentists and their employees, the CDA has developed the Colorado Dental Association Retirement Solution, powered by TAG Resources, LLC, the largest “end to end” 401(k) provider in the United States.

The Colorado Dental Association Retirement Solution allows members to offer a retirement plan to their employees, while reducing the administrative burden, transferring fiduciary risks and potentially reducing costs. Employers told TAG they wanted a 401(k) plan that is:

• • • • •

Easier to administer Keeps them in compliance Has substantial and well-known providers Protects from fiduciary liability Has reasonable costs

TAG, as the plan administrator and fiduciary, has partnered with Transamerica Retirement Solutions, LLC as Recordkeeper and with Mercer, LLC as the Investment Manager. By leveraging these well-known providers as your professional support team, the CDA Retirement Solution can reduce the administrative burdens in your plan, potentially save costs due to economies of scale, outsource fiduciary liability to the greatest degree allowed by law to help mitigate "The Colorado Dental fiduciary risk and provide a Association Retirement robust investment menu. A Solution allows members team of experts will support the compliance and management of to offer a retirement the plan. The program’s awardplan to their employees, winning participant educational while reducing the tools and resources can help your employees attain the retirement administrative burden, readiness they deserve.

transferring fiduciary risks and potentially reducing costs."

In the Spring 2018 Journal of the Colorado Dental Association, Darren Royal, President and owner of Royal Wealth Management, outlined the reasons dentists may want to offer a 401(k) plan, including the ability to attract and retain top talent to stay competitive. (See Everyone Wins When You Offer a 401(k) plan, Spring, 2018 Journal of the Colorado Dental Association) The CDA Retirement Solution allows each participating employer to take advantage of many plan design alternatives.

To learn more about the CDA Retirement Solution or for a proposal, contact Darren Royal, Royal Wealth Management, at (720) 733-9143 or darren.royal@lol.com or Greg Hill, CDA Executive Director, at (303) 740-

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6900 or greg@cdaonline.org.

Securities offered through LPL Financial, Member FINRA/SIPC. This information was developed as a general guide to educate plan sponsors but is not intended as authoritative guidance or tax or legal advice. Each plan has unique requirements, and you should consult your attorney or tax advisor for guidance on your specific situation. In no way does advisor assure that, by using the information provided, plan sponsor will be in compliance with ERISA regulations.

About the Author Greg Hill 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 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.

Award Winning Nobel Procera™ Bar Designer

THE RELENTLESS DENTIST

THE POWER OF DENTIST CLARITY

By David Maloley, DDS, FAGD

R

ecently, I was speaking to several hundred highachieving dentists at a conference. From the stage, I heard a collective gasp after I flipped to a slide with this quote on it: “Unhappiness is not knowing what we want and killing ourselves to get it.” - Don Herold.

Those words should then guide your leadership of the practice. Someone who uses the word respectful and honest to define who they are as a person will transfer those words into actions that help define the practice culture.

Success all starts with the “tone at the top”. Use these words to help you course correct when you’re tired, frustrated and not being your best self.

The quote had hit a nerve. Why? Many dentists are “successful” from the outside looking in. Yet they are left with chasing more.

“More” is a vague term and therefore that result is never fully realized.

What are three words that should define and guide how you engage and treat other people?

They may be building their practices by running themselves into the ground. They may be striving to be “enough”. Perhaps they are searching for meaning. Generally, they haven’t defined exactly what they want.

As a Certified High Performance Coach, clarity is the foundation on which all of my clients’ future successes are built.

Clarity, by definition, means coherent, intelligible, transparent or pure. These qualities need to be in place within yourself, as the leader of the dental practice, and throughout your entire team. Without clarity, everyone is working towards a different goal and no one is on the same page. That’s a very stressful and unproductive way to practice dentistry.

Again, these words should be a part of who you are and should speak through actions how you want others to be treated. If you have strong family values, you might take the time to get to know your patients and employees on a more personal level, so that you can tailor your conversations each time they come in for a definition, more personal experience.

"Clarity, by means coherent, intelligible, transparent, or pure. These qualities need to be in place within yourself, as the leader of the dental practice, and throughout your entire team."

What are three words that will remind you of what it is that made you the successful professionally, and will make you even more successful in the future?

These are called success markers. They are the drivers that will take you to the next level in your practice and in your life.

Clarity is not something that you are born with or is innately in you, it is something you must search out and strive towards. Clarity gives you a sense of meaning and priority in life.

Too often we don’t have what we want simply because we haven’t gotten crystal clear on what it is that we want.

Once you’ve gotten clear on who you are and who you want to be as a practice leader, it simplifies the process of defining what practice success and what success outside the practice looks like (health, relationships, etc).

In order to obtain clarity for your practice, you must first think about what it is that you want out of your dental practice. It’s most powerful to look at it through the lens of service. What do you most want to accomplish for your patients, team, family and community?

Avoid the trap of regret and unhappiness that comes from lack of clarity.

Make some time for yourself so that you can get hyper-intentional about your results. Give yourself permission to be selfish so that you can better serve.

Running a dental practice with clarity means you are looking at the big picture, or long run, as opposed to getting spun up in the day-to-day. It is easy to get caught up in the short term financial aspect of running a practice.

But, if you can seek clarity and work towards becoming a more effective leader, then revenue and fulfillment increases and stress declines. Creating a mission and vision statement for your practice is the right way to define what it is you want to accomplish. Also, involve your team in establishing some core practice values.

About the Author

Ask yourself the following three questions in order to seek out more clarity for becoming the best leader you can be for your dental practice.

Dr. David Maloley hosts the very popular podcast, The Relentless Dentist Show. He's a Certified High Performance Coach, a co-founder of DentalSuccessNetwork.com, and the coauthor of 'Titans of Dentistry.' David grew up working on a family farm in Lexington, NE. He attended the University of Nebraska, where he earned his bachelor’s degree and later his DDS. In 2003, Dr. Maloley completed a residency in Ft. Jackson, SC. He served as a Dental Officer in the US Army for five years. While serving in the Army, Dr. Maloley was stationed at bases in Giebelstadt, Germany and Vicenza, Italy providing general dentistry services for soldiers and their families. After he returned to

What are three words that define the best of who you are in your personal life, and can be used to guide your thoughts and actions?

the US in 2007, he worked at a private practice near Charlotte, NC for two

These words should have meaning and should define who you are as a human being. You would feel proud if a patient or team member defined you as such. Are you loyal, hard working, determined, honest, respectful?

Brux. You can reach him at Dr.Dave@relentlessdentist.com

years before relocating to Avon, Colorado to open Vail Valley Dental Care. He enjoys the Rockies with his wife, Karah, eight year old son, Bennett, and boxer,

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FEATURED ARTICLE

ELECTRONIC CURB APPEAL

Does Your Practice Need A Renovation?

By Justin Baltz, DDS

A

rguably, an effective website is the most important technology within a vital dental office. A website is the avenue to a steady source of new patients, which translates into a healthy work flow for dentists and staff.

Fewer patients are asking their neighbor who their dentist is and are instead relying on Google and other search engines for reviews and “electronic curb appeal.” Having a mobile first design has now become the gold standard for websites. Mobile first refers to a website designed for mobile devices (i.e. smartphones and tablets) and expand to desktop computers. This is important as up to 70% of new patient traffic will eventually come from mobile devices. Search engine algorithms reward websites a higher ranking for having this design. Individuals rarely look for a business on page two of a search engine, thus being on page one must be the goal.

So, how do you get to the top of a search engine such as Google? Search Engine Optimization (SEO) and Pay-Per-Click (i.e. paying search engines for specific searches like “implant dentist” or “oral surgery”) are two methods. Both can be effective, but, like everything in life, they come with a cost. Many SEO companies

claim they will increase new patient calls through increased web traffic; however, it is important to do your research as these companies are a “dime a dozen.” When you select someone to design your website, be sure to reference reviews, check out their clienteles’ websites, have them use customized content and remember to index your current website as to not lose the credibility of your previous site. If you intend to redesign your website as mobile first, select a reputable SEO company, index your previous website and track results when new patients call.

A new website can be a long and expensive process but remember how much you value your first impression with a new patient.

About the Author Dr. Justin Baltz is a partner at Highpoint Dental in Aurora, CO. Dr. Baltz is a member of the American Dental Association, Colorado Dental Association and Metro Denver Dental Society. He serves on the Mountain West Dental Institute Continuing Education Committee and the MDDS Board of Directors. Dr. Baltz enjoys snowboarding, cycling, Broncos/Packers football and competes in Ironman competitions.

WE HAVE AN EXCITING LIST OF PROGRAMS FOR 2018 DISC 2018 Schedule March 22 - Aldo Leopardi, BDS, DDS, MS, Prosthodontist Title: Clinical Realities of Implant Treatment for the Completely Edentulous Patient

All DISC events will be held at the Colorado Dental Association seminar facility located in Greenwood Village, Colorado.

Seating is limited. Please register early in order to guarantee your space.

In order to attend these sessions, you must be a DISC 2018 member.

April 26 - Mark Spatzner, DMD, Periodontist Title: Implant Design: Adaptation to Natural Anatomy May 31 - Daniel R. Cullum, DDS, Oral and Maxillofacial Surgeon Title: Immediate Molar Implants: Navigation and Crestal Sinus Elevation June 21 - Achraf Souayah, DDS, General Dentist Title: Comprehensive Surgical-Restorative Workflow for Bio-Esthetic Integration of Implant Supported Restorations September 20 - Mark Ludlow, DMD, MS, Prosthodontist Title: The Fully Digital Implant Placement November 1 - Erik Sahl, DDS, MSD, Periodontist, Title: Edentulous Ridge Augmentation: Diagnosis, Indications, Techniques, and Expectations

Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by state or provincial board of dentistry or AGD endorsement.

1/1/2017 to 12/31/2018 Provider ID# 217950

Continuing education credits are available.

(Total of 13 and 1/2 hours of AGD PACE credits)

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For additional information or to register, visit https://disc.events DISC IS POWERED BY

KNOWLEDGE FACTORY

Founded by a team of industry professionals who have been providing waste management services to Colorado for over 18 years, HCMWS proudly serves hospitals, clinics, laboratories, blood banks, dentists and funeral homes, as well as any facility that is looking for a safe and cost-effective way to dispose of their medical waste.

PO Box 1385 Colorado Springs, CO 80903-1385 info@hcmws.com 719-445-5044 720-319-9419 www.hcmws.com

Thinking about SELLING your Dental Practice?

Let Us Help

You Ensure Your

Legacy

Completed over 1700 transitions.

Larry Chatterley

Marie Chatterley

Appraisals • Practice Sales • Partnerships • Buyer Representation • Post-Transition Coaching • Start-Up Coaching • Associateships

Your dental practice is your legacy.

As dental practice transition specialists, we guide you through the complex process of selling your practice to ensure everything goes smoothly with the legacy you have built.

Complimentary Consultation

303-795-8800

“CTC Associates set us up for success! Their attention to cover every detail in the transition process, their calming and soothing advice (every time we felt that the whole deal will fall apart), their ability to complete the task to the very end, was just very refreshing to my husband and myself!” Dr. Balota www.ctc-associates.com 9233 Park Meadows Drive, Lone Tree, CO 80124 (303) 795-8800 | marie@ctc-associates.com | larry@ctc-associates.com

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Did You Know?

The Mountain West Dental Institute & Conference Center (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 & CONFERENCE CENTER 925 Lincoln Street, Unit B, Denver, CO 80203 | (303) 488-9700 | MWDI.ORG EVENT CALENDAR JUNE June 15 Nitrous Oxide/Oxygen Administration Training - Dr. Jeffrey Young Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am-4:00pm (303) 488-9700

September 21 Sleep Explained: The Science of Dental Sleep Medicine -Dr. Chase Bennett Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700

June 23 MDDS Summer Kickoff Event Dick’s Sporting Goods Park, 6000 Victory Way Commerce City, CO 80022 5:30pm - 9:00pm (303) 488-9700

September 28-29 Dental Laser Certification: Utilize Today’s Dental Lasers in Managing Periodontal/Soft Tissue Conditions -Dr. Sam Low Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

JULY

OCTOBER

July 21 MDDS Shred Event Rocky Mountain Orthodontics 650 W Colfax Ave Denver, CO 80204 9:00am - 12:00pm (303) 488-9700

October 6 CAD/CAM Dentistry Demystified -Dr. Justin Chi Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

SEPTEMBER

October 11 Freedom Day All Day (303) 488-9700

September 12 CPR/AED Training Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700

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October 12 Botulinum Toxin (Xeomin, Dysport, Botox) and Dermal Filler Training, Level I Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

October 13 Frontline TMJ and Facial Pain Therapy, Levels I & II Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

October 13 Botulinum Toxin (Xeomin, Dysport, Botox) and Dermal Filler Training, Level II & III Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700

NOVEMBER November 6 CPR/AED Training Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700 November 9-10 The Next Step in Bone Grafting & Implant Placement: A Two-Day Workshop Utilizing Cadaver Specimens -Dr. Charles Schlesinger Mountain West Dental Institute 925 Lincoln Street, Unit B Denver, CO 80203 (303) 488-9700 January 17-19 Rocky Mountal Dental Convention Colorado Convention Center 700 14th Street Denver, CO 80202 All Day (303) 488-9700

CLASSIFIEDS Real Estate: Longmont, CO: 2,533 SF of turnkey dental space available in Longmont. Singletenant building only 1 block from Main St. To learn more contact Greg Fair or Aaron Baney at The Colorado Group - 303-449-2131

GP for Sale: SE Metro Denver (CO 1621) LISTING UPDATE! Increasing revenue & income! Revs 800K, 4 ops + room for 1 more, 1500sf, Condo sold w/practice, Dr. Retiring. 303-759-8425, www.adsprecise.com, 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.

GP Shell for Sale: North Metro Denver (CO 1727) 10 Ops plumbed, 5 equipped, stand-alone bldg. w/lease. 303-759-8425, www.adsprecise.com, frontdesk@ adsprecise.com

GP in Aurora (CO 1816) 880k collections, 315k net income, practice must be relocated, dentist/owner desires to stay on email: frontdesk@adsprecise.com, 303759-8425.

GP in Pueblo (CO 1808) Dr. retiring, annual revenue 300K 3 OPS. email: frontdesk@ adsprecise.com 303-759-8425.

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

GP for Sale: Co Springs (CO 1726) “Startup?” NEW REDUCED PRICE – 100K! 8 Ops plumbed, 5 equipped, leased retail space, great location. 303.759.8425, www. adsprecise.com, frontdesk@adsprecise.com GP for Sale: Greater Boulder Area (CO 1807) Dr retiring, annual revenue $500K, 5 fully equipped OPS. For information please call 303.759.8425 or email frontdesk@ adsprecise.com GP for Sale: Aurora (CO 1739) Dr relocating, annual revenue $395K, 3 fully equipped OPS. For information please call 303.759.8425 or email frontdesk@ adsprecise.com 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: Southern Colorado (CO 1738) Dr retiring, annual revenue $325K, 5 OPS. For information please call 303.759.8425 or email frontdesk@adsprecise.com GP W Metro Denver, CO (CO 1809) Annual revenue $800K, 5 Ops, 2200 sf, Dr retiring. www.adsprecise.com frontdesk@adsprecise.com 303.759.8425 GP for Sale: Lakewood (CO 1717) NEW REDUCED PRICE – 225K! Revs 380K, 3 ops+1 plumbed, 1,365sf stand-alone bldg. for sale w/practice, Dr. Retiring. 303-7598425, www.adsprecise.com, frontdesk@adsprecise.com GP for Sale: Littleton (CO 1722), REDUCED PRICE!! 3 ops + room for one more, annual rev $750K, 1,400 sq ft, Dr. Retiring. 303-759-8425, www.adsprecise.com, frontdesk@adsprecise.com GP for Sale: Southern CO (1738) Well established, respected practice. 5 ops, revenue >300K, 1600sq ft, Dr. Retiring. 303-759-8425, www.adsprecise.com, frontdesk@adsprecise.com GP for Sale: Central Aurora (CO 1739) 480K Collections, 3 ops w/cone beam x-ray, Dr. relocating. 303-759-8425, www.adsprecise.com, frontdesk@adsprecise.com

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 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: N. Denver (CO 1136) Revs $1.3M, Price = $888K, 2 bldgs for sale, $3M for both. 8 Ops. Corporate inquiries only. 303-759-8425, www.adsprecise.com, frontdesk@adsprecise.com Perio for Sale: Denver Suburbs South (CO 1723) Annual Rev. $530K, 4 Ops/2 equipped, beautiful office, 1,964 sq ft. Dr. Retiring. 303-759-8425, www.adsprecise. com, frontdesk@adsprecise.com MEDICAL OFFICE SPACE FOR LEASE: 4185 E. Wildcat Reserve Pkwy, Highlands Ranch CO ( across from King Soopers and Starbuck) Building size: 25,585 sq ft.

Suite 210 is built out for dental practitioner with 5 operatories. For more information contact Marc Holmes: (720) 939-6741, marc.holmes@elevationcompanies.com or Marine' McKee (720) 448-6557 marine.mckee@elevationcompanies.com Dental Practice(s) Wanted: A small emerging group practice in Colorado is seeking to acquire locations outright or through a customized partnership and transition plan for success. Please contact Dr. Mark A. Birner, markbirner@gmail.com, 303-929-4027

Jobs: Associate Dentist Wanted: A small developing group practice in Colorado is seeking an associate dentist for an excellent opportunity, with potential partnership within 6-12 months. Residency experience at a minimum is required. Contact Dr. Mark Birner, Markbirner@gmail.com, 303-929-4027

Misc: Operatory Needed: General dentist looking for single operatory to rent 1 – 2 days per week. Close proximity to I-25 and Hampden Ave. ideal. Contact (303)758-4900 or (303) 770-6854 with available space.

Visit mddsdentist.com/classifieds to place an ad.

MDDS LAUNCHES NEW WEBSITE! Check out the new, userfriendly mddsdentist.com.

Features include:

• Continuing Education & Events Calendar • Continuing Education Course Registration • Career Center • Volunteer Opportunities • Online Edition of the Articulator Magazine • Easy Access to Member Benefits • And much more!

Stay tuned for more features and benefits coming soon!

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