MDDS Articulator Volume 16 Issue 4

ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Spring 2012 Volume 16, Issue 4

IT'S BUSINESS TIME! HELPFUL PRACTICE TIPS SO YOU DON'T HAVE TO BREAK THE BANK Reflections from the President 4 Avoid Breaking the Bank 8 Endo Panel Discussion 12 5280 "Letters to the Editor" 16 Employee Bonuses 22 Why is so Much Attention Given to Rate of Return 26

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ARTICULATOR MDDS

Connections for Metro Denver’s Dental Profession

Volume 16, Issue 4

MDDS Articulator Editor Carrie Seabury, DDS Managing Editor Jason Mauterer Creative Manager Chris Nelson Communications Committee Anil Idiculla, DMD, Chair Michael Diorio, DDS Karen Franz, DDS Kelly Freeman, DDS Brandon Hall, DDS Kyle Klepacki, DDS Jeremy Kott, DDS Maria Juliana DiPasquale, DMD Nicholas Poulos, DDS Maureen Roach, DMD MDDS Executive Committee President Charles S. Danna, DDS President-Elect D. Diane Fuller, DDS Vice President Mitchell N. Friedman, DDS Secretary Larry Weddle, DMD

mddsdentist.com

Spring 2012

Inside This Issue:

A Letter from the President..............4

Event Calander..............................20

The Powa' of Your Dolla'..................6

Employee Bonuses.........................22

Avoid Breaking the Bank.................8

Don't Miss the Shred......................24

Member Matters............................10

Why is so Much Attention Given to Rate of Return............................26

Endo Panel Discussion...................12 School of Dental Medicine Hosts 5280 "Letters to the Editor"............16

28th Annual Research Day.............28

The Minimally Invasive

Classifieds......................................30

Dentistry Umbrella........................18

Treasurer Scott M. Maloney, DMD Executive Director Elizabeth Price, MBA, CDE, CAE Printing Dilley Printing The Articulator is published bi-monthly by the Metropolitan Denver Dental Society and distributed to MDDS members as a direct benefit of membership.

Editorial Policy All statements of opinion and of supposed fact are 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 3690 S. Yosemite St., Suite 200 Denver, CO 80237-1827 Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com ©2011 Metropolitan Denver Dental Society

Member Publication

Get To Know Your MDDS Staff

Debra Arneson, CMP - Associate Director of Convention & Events This month we would like to introduce Debra Arneson. Debra joined MDDS in September 2010 to take the position of Associate Director of Convention & Events.

Originally from Wisconsin, over the years Debra and her family have made their home in the Northeast, Pacific Northwest, Southwest and the Rocky Mountain region. She moved to Colorado in the summer of 1999 and has been here ever since.

Debra grew up on a dairy farm in central Wisconsin; number four out of seven children.

Her parents instilled in them a strong work ethic as well as an appreciation for hard work, integrity and moral values. Debra has three grown children and two grandchildren. In her down time, Debra loves to read, hike, ski and ride her motorcycle.

She is also currently remodeling her home located near downtown Colorado Springs. Debra likes to volunteer her time for various community events.

She has worked with the Arthritis Foundation, the American Heart Association and Peak Education in the planning of their annual fundraising events.

In addition, she has completed the Pikes Peak Leadership Development Signature Course and sat on the Colorado Springs Economic Vision Council for two years.

Debra brings to us a wealth of knowledge in the meetings industry having planned events around the world in a myriad of different environments.

It all began when she started working for a large insurance company in St. Paul, Minnesota. Her first big conference was held in Switzerland followed by side trips to Austria and Sweden.

Loving the work and travel, she planned many a conference, convention, workshop and seminar over the next fifteen years. Seeking a career change in early 2000, Debra then worked in technology sales for the Oracle Corporation and Hewlett Packard. After several years in the corporate world, Debra decided to transition to non-profits and associations in order to expand her continuing desire to learn and experience new things.

As Associate Director of Convention & Events, Debra oversees the development, planning and management of the Exhibit Hall at the Annual Convention. She is also responsible for the recruitment and training of volunteers, and soliciting sponsorships and exhibitors. In addition, she develops, plans and implements continuing education and special events throughout the year.

Debra continues her industry education and recently passed the Certified Meeting Planner (CMP) certification exam. She serves as staff liaison to the Exhibits Sub-Committee.

You can reach Debra at (303) 488-9700, ext. 3274, or darneson@mddsdentist.com.

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A LETTER FROM OUR PRESIDENT Reflections from the President

By Charles Danna, DDS

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his year went fast. In retrospect, the last 36 years have gone fast. I am starting to go back through my files to see what needs to be transferred to our incoming president, Dr. Diane Fuller. I found an article I had written for the Rocky Mountain News in 1990. I was a member of the Public Relations committee at that time. Dr. Roger Anderson was the Chair of that committee. The article was about cosmetic dentistry, explaining bonding, composite fillings, bleaching and braces. The end of the article listed the phone number of MDDS as (303) 745-8500. How things have transformed in what I feel is was a short time.

The Rocky Mountain News newspaper is no longer in existence, Dr. Anderson has retired and MDDS’ location and phone number have all since changed.

I have seen a lot of changes in our society and profession. Most of them have been positive; however, you always have to take the bad with the good. The high and continually growing cost of a dental education is one of the biggest issues for dentistry today in my opinion. It is forcing new graduates to make decisions that our older members did not have to face when we started our careers. When I chose dentistry as a career it matched my goals for my future.

It was a profession that would allow me to have time to enjoy my family and to provide for them. I was also able to choose where I wanted to live and determine my own income. Today, I see a lot of those choices being taken away from some of our new members because of financial concerns. In stating this, I think one of the best changes I have seen in our society is the effort to address our new members’ needs.

I am proud of the hard work our committees

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are doing to include our new members and to create an interest in organized dentistry.

Hopefully our committees are communicating the message to these new members that they are not alone and that our society is here to help them throughout their career. I am excited about the transformation of the makeup of our Board of Directors. When I look at our members on the board it seems that the gray haired members are starting to disappear. We have a strong board that is aware of the trials that our new members are facing. I always enjoy talking with one of our active committee members, Dr. Eric Rossow, about new members. He plainly describes the issues of our new graduates. Having this type of input helps

“Hopefully our committees are communicating the message to these new members that they are not alone and that our society is here to help them throughout their career."

MDDS address the needs of our members. For this year's RMDC I choose a younger chairman, Dr. Ian Paisley, to coordinate the event. The convention definitely had key attractions for our younger members. The program had a lot of courses to help build a successful practice.

There was definitely a younger feel when it came to the parties. The Friday Night Party was a huge success and the after party was packed.

My wife, Tonya, and I made an appearance at the after party even though it was after our bedtime. My doctor informed me that my hearing may return in a few more weeks.

Speaking of changes, I remember when the convention was packed into the old Currigan Hall and the C.E. courses were spread around

the hotels in the area. It had the appearance then of just a trade show. The new convention center opened the day after President Bush initiated Desert Storm. I was seated in our first class of the day when the alarms went off throughout the center. Everyone evacuated the building and there was a lot of concern because of the political climate at the time.

The thing that stayed with me was how huge of a convention center we had moved into that year. It was an amazing change from the old Currigan Hall and has become a great home for the RMDC. This year the RMDC was a huge success. I feel that all of the attendees had a great experience. We received positive feedback from our members, the lecturers and the exhibitors. The RMDC is a benefit our society can continue to build on and improve.

I want to thank the staff of MDDS for all of the support and effort they have provided throughout the year. I see great things happening in our society for years to come.

The staff is constantly working on improving the services and benefits offered to our members. Together, with the legislative work done at the CDA and the ADA, as well as the ADA scientific research, the tangible and intangible benefits of the tripartite can’t be matched. We are all fortunate to have these three organizations working for us daily.

It has been a fun, fast year and I look forward to the changes in store for our society. I am confident in the future leadership of MDDS. It has been an honor to represent MDDS and I will always look upon this last year as one of the better experiences in my career.

Sincerely, Chuck Danna, DDS

Articulator – Spring

MDDS NIGHT at the

Colorado Rockies vs. the Miami Marlins Saturday, August 18, 2012 BBQ starts at 4:30PM Game begins at 6:10PM

Bring your Friends and Family to Watch the Colorado Rockies beat the Miami Marlins!

Hosted by:

REGISTER ONLINE at mddsdentist.com. If you have any questions contact Debra Arneson, Associate Director of Convention & Events, at darneson@mddsdentist.com or call (303) 488-9700.

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REFLECTIONS The Powa’ of Your Dolla’

By Carrie Seabury, DDS

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eeing as how this Articulator issue’s theme is business and financial, it only seems appropriate to share with you the brilliance of my very first financial advisor, 50 Cent. In his song, “I Get Money,” he proposes many exceptional ideas on ways to gain financial success. Although it is wonderful to have an advisor that can give me so many options, I quickly discovered a minor problem with using 50 Cent as my go-to guy. Firstly, he doesn’t release financial-advice-rapsongs (a fly new musical genre) quickly enough to prevent my portfolio from becoming stagnant. More importantly, he never seems to return my calls.

Most of us float through life with very little schooling on managing personal and business finances. Like so many dentists before me, my practice thrives due to of a combination of advice from veterans, a handful of continuing education hours, and quite frankly, throwing some stuff on the wall to see what sticks.

The veteran who gives me most of my financial advice is a little old man who works in a little old office who has a little old thing called a financial planner certification. Once in a while my husband and I drop in and visit with him. Although our meetings with our CFP are not as cool as my meetings with 50, we chose our CFP because he has mastered two important skills when interacting with his clients. Rule of engagement #1-Always flatter the wife.

(Works for me.) Rule #2-Give her an important sounding title and some sweet new acronyms after her name. (Thumbs up.) The first time my husband and I met

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with our CFP, he addressed me as the CEO and CFO of my household since I make most of the purchasing decisions, and I do the bills and (attempt to) do the household budgeting. As much as I love collecting fancy acronyms, I started to get that uneasy feeling that I have not been properly trained for this job title.

There are a ton of financial decisions to make for a household of 5 humans and 2 dogs. Purchasing decisions in particular cause the most stress for me. I know I am supposed to clip coupons, seek out (and use) groupons, use consumer

“How am I making my purchasing decisions, and what is the resulting effect on my practice and my dental community?” research websites and wait for sales.

Unfortunately, I don’t have the time to cost compare which store offers the lowest price on the new Star Wars Darth Maul double ended light saber. My kid is turning six. His birthday party starts in four minutes. I need the saber now man.

Compound my household purchasing pressure with my practice purchasing pressure and the pounds per square inch inside that pressure cooker are enough to process a full maxillary denture.

Boom! See what I did there? That was a brilliantly nerdy dental metaphor.

We all need stuff. Sadly, the art of trade is a dying form – rarely do I get to trade a chicken for a handpiece anymore, so I am left with only one option. I have to buy stuff with actual money. And here is the worst part. I have to decide where to buy my stuff. Who will be the beneficiary of my quest for the perfect

impression material? Who will be my champion and sell me an unbreakable digital sensor that I can drive my Toyota over? Where is the dental supply company that can grant my one request for some sharks with some lasers attached to their heads? That’s all I’m asking for. Lately, I have been paying more attention to my purchasing decisions. I have been asking myself, “How am I making my purchasing decisions, and what is the resulting effect on my practice and my dental community?”

I used to be the dentist who bought whatever I needed at the moment I needed it from whoever was in front of my face. Immediate gratification? Sure.

Bet your bottom dollar that the Darth Maul saber is on it’s way in 3 business days or less. But I’ve noticed some subtle changes in my buying habits lately.

My lead dental assistant opened my eyes to my first shift. She does all my dental supply ordering and has taught me the value of loyalty. I know. I catch the vibe that nowadays many people feel like loyalty is a concept that is as obsolete as Michael Bolton. (Although for my money it doesn’t get any better than when he sings “When a Man Loves a Woman.”) The commitment involved in even contemplating loyalty just makes our right nostrils twitch a little bit, doesn’t it? The idea of loyalty died right around the time the Garbage Pail Kids trading cards were no longer cool.

But low and behold, I have seen loyalty work miracles in my office. Sterilizer down? Dan, my Schein rep, walked in wearing his Superman cape holding a loaner sterilizer in the nick of time so we didn’t have to close the office.

Server acting wonky? Nick, my IT hero, Articulator – Spring

responded within minutes to whisper the magic nerdcommand into my server’s ears and we continued with our day. I have learned that loyalty to my support team is paramount. Those miraculous moments taught me that I cannot survive without my superheroes and for that, I give them my undying loyalty.

My other shift occurred more recently at this year’s RMDC meeting. I realized the power that my dollar represented to the entire conference. We are lucky to have one of the largest, most commanding conferences in our country.

RMDC draws many of the most influential, soughtafter speakers. All of this magnificence and splendor happens right here in our backyard. How fortunate are we? Our collective Colorado brains are some of the most educated, up-to-date bad boys in the nation! Does MDDS pay these speakers with the money from our members’ dues? Hardly, my sweet doe-eyed friends.

The bulk of the money for our conference comes from our sponsors and booth exhibitors. They are the ones that make that RMDC magic happen every year.

RMDC planning committee’s new Powa’ of Your Dolla’ movement. I only want to buy from companies that support the RMDC. Since most of our big vendors are already supporters, it’s a pretty easy resolution. However, when I run into the vendors that are not exhibiting in our great hall, I’m going to mention that they had better get on the RMDC gravy train if they want me to buy their supercool enamel rod cloning device.

I love my city, I love my MDDS colleagues, and I love my conference.

I am going to truly embrace the powa’ of my dolla’ and I encourage you to do the same. Once you do, you have earned the right to an important sounding title and a few extra acronyms after your name. Congratulations my friend.

Sincerely, Carrie Seabury, DDS, CEO, CFO, LTTREPOYDM (Loyal to the Redonkulously Effective Powa’ of Your Dolla’ Movement)

Once my eyes were opened to this realization, I made a New Year’s resolution.

This year I am joining the mddsdentist.com

Articulator – Spring

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AVOID BREAKING THE BANK Practice Transitions and Taxes

by Larry Chatterley and Randon Jensen

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axes. Ugh. The word alone is enough to leave a taste worse than alginate in your mouth. And most would agree that paying taxes is worse than a molar root canal, either giving or receiving.

So how does one write an article about taxes and make it interesting? By exploring ways to avoid them or make them lower. At least that is the only part of taxes we find appealing.

We assume you agree, otherwise you would stop reading this article right now.

Since you are still reading, we are glad you agree. So, short of running for Congress and single-handedly reforming tax law (which, given the state of Congress, is less likely than growing a third set of teeth), what can you do to lessen the tax liability you incur from the sale of your practice? You have worked hard your entire career to earn a decent living and build something of value. It only makes sense that you should be allowed to retain as much of that value as possible and turn the least

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amount possible over to government to “use” as it sees fit.

So let’s explore some tax mitigation strategies associated with a practice sale.

Stock Sale. If you are incorporated, a sale of the stock in your corporation to the buyer of your practice will potentially yield you the greatest tax savings because the sale of stock is almost exclusively taxed at the lower fixed capital gains rate as compared to the higher, tiered ordinary income rates. However, and this is a BIG however, stock is a non-depreciable asset to the buyer. As such, the buyer is not able to write off the sales price and essentially ends up buying your practice with aftertax dollars. Consequently, a buyer is likely only to agree to buy your stock if you are willing to reduce your purchase price by 30 percent or more. For this reason (and all of the associated legal and liability complications), almost all dental and dental specialty practices are sold as “asset sales.” In other words, the seller retains his/her corporation and all of its stock and instead

Articulator – Spring

FEATURED STORY sells all of the tangible and intangible assets of the corporation (i.e., the practice) to a buyer since a buyer is then able to depreciate and amortize (write off) the entire purchase price over time.

Price Allocation. The IRS requires the total price of a practice be allocated to the various types of assets being sold and that the allocation be made according to the fair market value of the assets. As a general rule, the tangible assets are taxed as ordinary income above basis, and the intangible assets are taxed as capital gains.

(Above basis means the difference between what you are selling the tangible assets for and your book value or depreciated value.) Any consideration for a covenant not to compete will also be taxed as ordinary income. Since “fair market value” is somewhat subjective, there is some room for negotiating the overall allocation of the purchase price. As a seller, it will benefit you (and by that, we mean you will save taxes) if you can negotiate with a buyer for a lower allocation to tangible assets (viz., equipment, furniture, fixtures, supplies, etc.) and a higher allocation to intangible assets (viz., goodwill and patient records). However, it will benefit the buyer to have just the opposite allocation, so consideration must be given to making the allocation fair to both parties.

Susan H. Moore, CPA, who works with many dentists in Colorado, said “the IRS requires that the purchase/ selling price of a practice be separated into various components, such as furniture, equipment, goodwill, covenant not to compete, patient

mddsdentist.com

records, consulting, supplies. The buyer and seller must agree on the allocation and attach a form with their income tax return reporting the allocation. There are significant tax savings and tax consequences to each party in connection with the allocation. It is time well spent to understand the tax consequences with your accountant on each component and obtain the best allocation possible by each party.”

Seller carrying back a note. Since most of the remainder of the sales price will be taxed as capital gains and since the capital gains tax rate is a fixed rate, irrespective of ordinary income or ordinary income tax rates, the same tax will be applied and the same tax amount owed whether you receive that portion of the price now or whether it is paid to you over time; unless there is a change in the capital gains tax rate before the note you are carrying is paid off. Otherwise, selffinancing a portion of the price serves only to defer capital gains tax, but it will not lower the total tax. Therefore, we usually do not see many sellers carrying back a promissory note on the sale of their practice.

Sale Timing. As discussed above, the tax associated with recapture over basis on the sale of tangible assets will be determined by your ordinary income tax bracket in the year of the sale. If you are planning to retire after the sale of your practice, and consequently, will have a drop in your ordinary income level, it may behoove you to strategically time the sale of your practice until after the start of the next tax year.

“C” Corporation Consideration.

If you are currently incorporated and being taxed as a regular “C” Corporation, the sale of goodwill by your corporation will likely be subject to double taxation– once as capital gains inside your corporation and then again as ordinary income when paid as a distribution to the shareholder(s).

There is some case precedence that allows for the shareholder(s) of “C” Corporations in closely held and professional businesses to sell goodwill individually, outside of the corporation, thus avoiding that double taxation. If this applies to you, consult with your CPA and/or tax attorney regarding the details of such a tax strategy and its application to your particular situation.

1031 Exchanges. If you are selling a practice now and are planning to buy another practice within six months, a 1031 or “Like Kind” Exchange may be a tax deferral strategy to consider.

It allows you to defer the taxes associated with recapture over basis you would otherwise incur with the sale of your tangible assets. A 1031 Exchange has very specific and rigid requirements to accomplish correctly.

The specific details and mechanics of this tax strategy are beyond the scope of this article. As such, consult with your CPA and/or tax attorney regarding the details of such a tax strategy and its execution.

Mr. Larry Chatterley is a consultant with CTC Associates, Dental Practice Transition Consultants. He can be reached at (303) 795-8800 or at larry@ctc-associates.com.

Articulator – Spring

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MEMBER MATTERS

Membership Spotlight: Brett R. Levin, DMD Dr. Bret Levin practices general dentistry at Levin Family Dental in Denver. He has served on numerous MDDS committees is the 2013 Rocky Mountain Dental Convention Committee Chairman.

Q. Who or what pulled you into organized dentistry and MDDS in particular? What originally grabbed your attention?

A. There was no one calling that led me into organized dentistry. It was just another way to give back to the profession that has really given me so much. You get to interact with your colleagues, but on a different level than just talking teeth.

Q. What is your favorite benefit of being involved in MDDS/CDA? What do you gain from your involvement?

A. My favorite benefit from MDDS is the collaboration I get with my colleagues.

You get to meet some wonderful people.

Q. Tell us more about your other community involvement.

A. I have worked with the Give Back a Smile program through the AACD. It was before we had the MDDF to support locally. I worked with the Rocky Mountain Survivor Center and Stout Street. Through these experiences I learned that with any of these foundations, you work with people who have had a very rough life.

This is one way to help them re-integrate into society. They are so grateful that someone takes the time to help them.

Q. What do you think the main purpose/focus should be for MDDS? A. MDDS is here to serve the members. There are a lot of resources that a member can tap, whether you are involved with a committee for MDDS or the RMDC. The staff at MDDS is wonderful and very committed to helping all our

members. We all know there are many hurdles to practicing dentistry, and the resources they offer are second to none.

Q. What aspect of your dental career have you enjoyed the most?

A. There are two areas which are the most rewarding for me in dentistry.

These are in no particular order. First is being able to develop long-standing relationships with patients and families. We are fortunate enough that we have seen four generations of families in our practice. They become more than patients; they become friends. You really get to know someone over the course of decades and that interaction is wonderful. I think we have been able to provide real quality dentistry and only do what is necessary and that is why we continue to see so many generations of families.

The other thing that I find most rewarding is being able to change someone’s life. I know that may sound dramatic, but many patients have a disability due to their teeth. As dentists we take that for granted, since most of our patients take decent care of their teeth. Working with the various foundations, and seeing how grateful someone is to just “have teeth” is really special. Doing a big reconstruction case is also a lot of fun...it can be challenging, but fun. When you can show the patient the end result and then see tears of joy, or receive a thank you card saying how you have influenced their life...it's just hard to put a price on something like that.

It does not happen every day, but when it does, what a great feeling.

One more thing. Dentistry can seem like a very isolating profession, as most dentists are solo practitioners. I was extremely lucky that I had my father and now Dr. Jen Derse to work with. It is great to bounce questions off one another.

For those who don’t have another doctor to work with, the MDDS can provide that link to meet other doctors and help develop a support/study group. This is an extremely difficult profession, and we are all in this together. Each person has good days and bad and being able to share that with others is important.

MDDS Night with the Avalanche – March 24, 2012

The MDDS Night with the Avalanche was a huge success thanks to our sponsors, QSE Technologies and Cleartooth. With the help of an ADA Membership for Growth Program Grant, ten 3rd and 4th year dental students from the University of Colorado School of Dental Medicine were able to attend for free. The MDDS Member Services Committee also provided tickets for six new members. The game was an overtime nail-biter that unfortunately swayed towards the Canucks.

In the Pepsi Center cheering on the Avs

3rd year dental students Tom Rowe, Derek Owens and Craig Owens

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Attendees enjoying the meal at the Tailgate before the game

Articulator Editor Dr. Carrie Seabury showing her team spirit

Dr. Charles Danna and his wife Tonya enjoying the buffet with friends at the Tailgate

Articulator – Spring

New Members - Welcome!

Dr. Joseph R. Abt Dr. Dennis R. Bailey Dr. Darby Barfield Dr. Karine Barizon Dr. Robert C. Berry Dr. Monica Borris Dr. Eric S. Chatterley Dr. Jeffrey R. Crane Dr. Brandon J. Holyoak Dr. Kunjan Kakar Dr. Ashley N. Killin Dr. Ahmed Kohell

Dr. Lindsay L. Lichtenberg Dr. Aaron T. Lidde Dr. Chris Mun Dr. Timothy Nichols Dr. Kendra N. Ousley Dr. Babak Shahrokh Dr. Edmund J. Steigman Dr. Stephanie S. Stratil Dr. Jolyn Su Dr. Tam T. Than Dr. Sonya E. Villarreal Dr. Kenneth F. White

MDDS New Member Networking Event – Feb 2, 2012 Thank you to Henry Schein Dental for sponsoring this event.

For information about upcoming MDDS member events, visit mddsdentist.com.

2012 }

it’S going to be a great year:

}

March 29 MIS Implants Technologies Inc.

}

May 17 Implant Direct Sybron International

A paradigm shift in treatment planning; save the tooth or place an implant with minimally invasive grafting techniques dr. david anson, Periodontist Beverly Hills, California

Narrower diameter and shorter length implants

dr. John cavallaro, Prosthodontist Brooklyn, New York

Location: MDDS Building, 3690 S. Yosemite Street Denver, Colorado 80237 Members and Henry Schein Dental reps mingling at the Blake Street Tavern

Time: 5:30 PM to 8:30 PM /// Complimentary light dinner at 5:30 PM. Lecture begins promptly at 6:00 PM. /// CE credits are available. Fees for 2012 are waived due to corporate sponsorship.

Please Note: Capacity is limited. If interested in attending, please call 720.488.7677 to reserve your place.

aldo leopardi, bdS, ddS, MS Prosthodontist /// P. 720.488.7677 /// f. 720.488.7717

Scan thiS code for the full Schedule or viSit: Dr. Charles Danna with Bill and Malik, members of the UCD Pre-Dental Club

www.knowledgefactoryco.com/disc-schedule-2012

John from Henry Schein, Bryant Franz and Dr. Karen Franz

mddsdentist.com

Articulator – Spring

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PERSONAL WELLBEING Endo Panel Discussion Featuring Jeremy Kott, DDS (Denver), Gary Pascoe, DMD (Englewood), and Scott Maloney, DMD (Denver, Greenwood Village)

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hen evaluating the best treatment for an infected tooth, there are many options. We interviewed three local MDDS member endodontists to gain insight on the options available to our patients.

Q. What types of factors go into your decision making process when deciding whether to recommend a retreatment, an apicoectomy, or an extraction?

Dr. Kott: One of the first things I look at is whether the tooth is restorable. If the answer is yes, then I typically try to find out why the initial root canal failed. When a root canal treatment is failing, my first preference is always to retreat it, rather than performing an apicoectomy. I also like to know how many times the tooth in question has been treated. The more often a tooth has been treated with orthograde treatment (root canal and retreatment) the less likely a retreatment is going to work. It is at this point I consider an apicoectomy. Other reasons I consider performing an apicoectomy first, rather than a retreatment, include the presence of posts and well done root canals. In the anterior, removing posts through crowns can be a difficult task, especially when trying to preserve a crown. And a well done root canal, with no obvious reason for failure, is less likely to respond to orthograde treatment again. Things that may preclude me from recommending an apicoectomy include the tooth’s position in the arch, a thick buccal shelf in the mandible, and the apices proximity to the IAN just to name a few.

Retreatments can be successful, between 70-80% depending on the study, especially if you can correct the reason for failure. One way to measure how successful root canal therapy can be is to look at the survivability of a root canal treated tooth. Survival is defined by the treated tooth remaining in the mouth and functioning. One study, analyzing nationwide insurance data, looked at more than 1.4 million root canal treated teeth and found that within an eight year follow up period that 97% of initial root canal treated teeth were retained.

Dr. Pascoe: Determining the most appropriate treatment option for patients with failing or non-healing endodontic therapy can be challenging. I will initially attempt to determine the etiology of the problem. I tend to perform endodontic retreatment the majority of the time. Apical surgery can be helpful in cases where endodontic retreatment is

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complicated by large/long posts, complex coronal restorations or limited opening. I will always review options with patients as well as my feeling on the prognosis of the treatment options.

Dr. Maloney: Given the question being posed, we are to assume that RCT has been previously performed and the tooth currently either has a lesion that has increased in size or is symptomatic. There are multiple reasons why a previously treated RCT may have such a presentation. The term most often associated with this condition would be endodontic failure. This failure may be the result of a missed canal, an overfill or underfill, inadequate instrumentation, a cotton pellet being left in the chamber, separated instruments, lack of a proper rubber dam or NaOCl during the original treatment or any other iatrogenic outcome. Another category that should be considered is post treatment disease; this includes findings such as recurrent decay or leaking restorations, cracks, cysts or a fracture that results in exposure of the gutta percha. These are new etiologies that were not present at the time of the original RCT and therefore are not categorized as failures. The common element in all of these situations involves bacterial contamination.

One additional consideration is the presence of a radiolucency in a tooth that is actually resolving. We now understand that complete healing of a radiolucency associated with a previous RCT may, in some large lesions, take up to four years for normal radiographic findings. Therefore, just because we see an apical radioluceny, it does not automatically mean there is active disease. Along the lines of a persistent radiolucency, a periapical cyst differs from a granuloma in the fact that it does not respond to nonsurgical endodontics. A cyst can be successfully treated with surgical endodontics. In such a case an extraction would be effective, yet at the expense of a natural dentition that may have been maintained with apical surgery.

Despite the significant advances in our specialty there are still circumstances where saving the natural dentition may not be the patient’s best choice. First and foremost if the tooth has a poor restorative or periodontal prognosis then endodontic treatment modalities are not indicated. The most common periodontal issue, which is not amenable to treatment, is the presence of a vertical root fracture. Clinically this may present with an isolated deep probing depth, a sinus tract and a large radiolucency involving either the furcation or lateral aspect of the root surface. Surgical procedures such as hemisections and root amputations are seldom indicated given the

Articulator – Spring

potential of implants; however in rare instances they may find a place in a modern treatment plan.

uses, particularly retrograde fillings. I use this material routinely. The development of new materials and therapies in our specialty provides excitement and the increased probability that we can help maintain our patients' natural dentition.

Q. What newer materials and technology do you utilize in your office?

Dr. Kott: Most endodontists in the last 15-20 years have adopted using the operating microscope, which allows us to visualize much more than we ever could before. Because we can see so much more, it makes it easier to remove old obturation material, remove separated instruments and posts, and it gives us the ability to locate cracks in teeth.

I prefer to do my retreatments in multiple visits, usually two. This gives me the ability to place calcium hydroxide paste into the canals to act as a slow release antibacterial between visits.

Dr. Pascoe: Magnification is absolutely essential to provide the type of specialty care expected by an endodontist. I use a combination of loupes and a surgical operating microscope. Typically I use loupes for accessing the tooth and proceed to use the surgical operating microscope once I reach the pulp chamber and canals. I then use the microscope the remainder of the procedure. During surgical procedures the microscope is very important for inspecting the root for fractures in addition to precision preparation of the root end for retrograde filling placement.

Dr. Maloney: The recent advances in our specialty including: microscopes, ultrasonics, NiTi instruments, irrigation solutions and medicaments, greater awareness of canal morphology, cone beam technology and regeneration techniques have afforded us abilities to save the natural dentition where such treatments would not have been possible in the recent past. Prior to considering an extraction, a thorough endodontic evaluation should be conducted informing the patient of all potential options and their prognoses.

As endodontists it is our mission to save teeth. The decision to maintain the natural dentition through either surgical or nonsurgical options should be based on sound clinical judgment and careful weighing of the risks versus benefits. The materials, techniques and tools currently in our arsenal allow us an excellent chance of eliminating bacteria from the root canal system in a highly predictable manner. This allows us to achieve our ultimate goal of returning the tooth to a healthy status of comfort and function.

Articles of Reference for further information on the topics discussed in this issue’s Endo Panel: Kenneth M. Hargraeves. Treatment Planning: Comparing the Restored Endodontic Tooth and the Dental Implant. Endodontics: Colleagues for Excellence. Summer 2007

1.

One of the newer materials I am using is Qmix in addition to sonic activation of irrigation solutions. The idea is to achieve the greatest amount of disinfection of the canal system as possible and these newer materials and techniques are helping. Although not a new material, I also use calcium hydroxide as an intra-canal medicament to provide increased disinfection in certain situations. Mineral trioxide aggregate (MTA) has been a wonderful development for a number of

The Public Relations Committee is in need of some committed volunteers!

If you’re interested in volunteering for this or any other MDDS committee, please contact Jennifer Wissel, Events & Membership Manager, at jwissel@mddsdentist.com or (303) 488-9700.

mddsdentist.com

Syngcuk Kim, Samuel Kratchman, and Garrett Guess. Contemporary Endodontic Microsurgery: Procedural Advancements and Treatment Planning Considerations. Endodontics: Colleagues for Excellence. Fall 2010.

2.

Social Media Tip! Protect Your Facebook Page by Rita Zamora Do you know how to access your Facebook Business Page? Or who has access to it? Doctors can help protect their Facebook community by learning how to personally access their page.

Facebook recently announced they will be implementing a new option to allow page owners to assign different privileges to page administrators. This new option should allow doctors to protect their page by preventing admins from taking over or deleting owners' pages. Rita Zamora is owner of Social Media Marketing for

Dental & Medical Professionals. You can contact her at (303) 807-3827.

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13

The Colorado Convention Center with iconic Blue Bear peeking in

Attendees entering the Expo Hall for the first time at the 2012 RMDC

Opening session with Ms. Karyn Ruth White

T

he 2012 Rocky Mountain Dental Convention could not have been such a success without you! We would like to extend a warm “Thank you” to all of our attendees, exhibitors, sponsors, and especially our volunteers.

We look forward to seeing you all at the 2013 RMDC.

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Volunteers: Ms. Kristin Adkins Dr. Roger Anderson Ms. Ann Marie Bandach Dr. Nelle Barr Dr. George Beilby Ms. Myra Bender Dr. David Bennett Dr. Gary Blumenschein Dr. Roger Boltz Dr. Paul Bottone Dr. Janie Boyesen Dr. Brian Brada Dr. Terry Brewick Dr. Brian Butler Ms. Marcella Cardona Dr. Lisa Carlson-Marks Dr. Marc Carpenter Ms. Elsa Castro Ms. Amanda Chavez Ms. Linda Chin Dr. Nick Chiovitti Ms. Chelsey Crawford Dr. Eric Dale

Dr. Charles Danna Ms. Tonya Danna Dr. Kimberly Danzer Dr. Erica Derby Dr. Michael Diorio Dr. Michael Duryea Dr. Terry Egert Dr. Patrick Foley Dr. Russell Ford Dr. Karen Foster Dr. Mitchell Friedman Dr. Diane Fuller Dr. Larry Gabler Dr. Debra Gander Ms. Becky Garrison Dr. Jennifer Garza Dr. George Gatseos Ms. Janet Gatseos Dr. David Geck Dr. Jayme Glamm Dr. Paul Glick Dr. Richard Goad Dr. Guy Grabiak Ms. Rebekah Gresham Ms. Margaret Guerrero

Roger, Kevin, Christian and Colin of Carr Healthcare Realty

Dr. Alan Gurman Dr. Colleen Halligan Ms. Felisha Harshman Dr. Douglas Heller Ms. Chris Hillenbrand Dr. Keaton Howe Dr. Curtis Johnsen Mr. Willie Johnson Dr. Jed Jultak Dr. Jeff Kahl Dr. Kai Kawasugi Dr. Bradley Kellogg Dr. Brett Kessler Dr. David Klekamp Ms. Jennifer Klekamp Dr. Beth F. Kreider Dr. Chandra Kreider Ms. Laura Lamos Dr. Brett Levin Dr. Ken LeVos Dr. Stace Lind Dr. Clifford S. Litvak Dr. Jeffrey T. Lodl Dr. David Lurye Dr. Scott Maloney

Dr. Erik Mathys Ms. Brenda McNulty Ms. Grace Meeker Dr. Deborah Michael Ms. Trease Miller Ms. Lori Mirelez Dr. Sheldon Newman Ms. Lin Newman Dr. James Nock Ms. Leigh Olson Dr. Michael Ontiveros Dr. Ian Paisley Ms. Kim Panteloglow Dr. Michael Petersen Dr. Ron Resnick Dr. Jennifer Rohleder Dr. Eric Rossow Dr. Ellen Sachs Dr. Chris Sakkaris Ms. Sara Salter Ms. Katherine Savage Ms. Peggy Schafer Dr. Rachel Schallhorn Dr. Carrie Seabury Dr. Mark Shimoda

Ms. Sherri Simpson Dr. Bernard Slota Dr. Ryan Soden Ms. Kristy Stallsworth Dr. Heather Stamm Ms. Laura Tappero Dr. Christine Taylor-Keith Dr. Robert Teitelbaum Dr. Terri Tillis Mr. Jay Tippets Ms. Jessica Twibell Dr. Eric W. Van Zytveld Dr. Michael Varley Ms. Suzanne Varley Ms. Lauren Vavala Dr. Kenneth Versman Dr. Stefanie Walker Dr. Larry Weddle Dr. Eric Winter Dr. Richard Worley Dr. Hesham Youssef

Dr. Terry Tanaka speaks at the RMDC

An aerial view of the Expo Hall

An attendee trying out new products in the Expo Hall

The Expo Hall in full swing

Dr. Ian Paisley, Convention Chairman, during opening session

Mrs. Amy Boymel checking out the RMDC Articulator in the Tripartite Lounge of the Expo Hall

MDDS President Dr. Charles Danna at his reception

Testing out some relaxing massage chairs in the Expo Hall

The Friday Night Party

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5280 Letters to the Editor

We received some responses and encouragement from our Winter issue’s 5280 article.

Here are some of our members’ thoughtful comments.

Dear MDDS:

Hi MDDS,

I am always disappointed when I see one of these 5280 lists, mostly because the selection process seems opaque. For many years I was the patient of a physician who by coincidence was on the list perenially.

Thank you so much for your article about 5280 Magazine. I have been listed as a "Top Dentist" for three years and find it very flattering, but also had concerns about the process. I saved the email I sent to 5280 about my concerns. There probably isn't anything new to you, but thought I would share it with you and tell you that I appreciate your efforts.

When I changed docs- my choice-it was a breath of fresh air. To this day I don't get why he was always on the list. About four years ago I received a survey asking my opinion of who the best dentists were in my town of Parker, Colorado. Presumably it was sent by the USA Top Dentist company. It stated that I was gathering info for the 5280 Top dentist award. I don't recall the specific questions, but I do recall ignoring the survey because it provided a list of local dentists who were candidates for the Top dentist award.

The list jumbled specialists such as orthodontists and oral surgeons among the general dentists.

As if that wasn't off-putting enough, the list contained about 15 names and my recollection was that at that time there were perhaps a total of 25 general dentists in Parker. Conspicuously absent from the list was my own name- even though I had been practicing in Parker for more than 12 years at that time, and in Denver for 28 years. Also missing was the name of my then partner who had been practicing in Parker for more than 20 years and has a really wide following here. I don't know exactly how it would work best to get a fair sampling of local dentists.

Clearly, though, using an out of city, or worse, an out-of-state company such as USA Top Dentist isn't working. One idea would be to ask the specialists who see the work of the general dentists.

Conversely, general dentists could be asked about the specialists.

The least they could do is run the survey by the dental society locally to check that the names provided are in fact generalists.

Sincerely, Dr. Bob DiGiorgio

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By: Carrie Seabury, DDS

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Here are my thoughts: 1) It is very flattering to be in 5280 and good for one's ego.

2) It does not increase new patients appreciably.

3) Due to the large number of dentists in the issue, it works out to approx one out of every eight dentists in the state of Colorado.

4) The ballots that are sent out are not accurate (i.e. dentists who have died or retired continue to be listed and others are listed under incorrect specialties), which decreases the credibility of the process.

Dr. Kate Hakala MDDS, As I see it the only FAIR WAY is to have a letter directed to general dentists that asks them for a recommendation for this honor and politely state that the person should vote for 2-3 (or whatever number) of general dentists that are to be considered above average and of highest respect ethically and technically.

Then a similar type of letter to each of the individual specialties.

The generalists and specialists need to evaluate their own peers - otherwise if the general dentists and the specialists mix/vote for the others it will be only a REFERRAL GAME and not an evaluation of their peers. I always wondered how they were picked knowing that many good ones were but there were many that were more capable and they weren't selected.

Don Vollmer, DDS

Articulator – Spring

FEATURED STORY We would like to thank our members for their feedback and always welcome more comments and concerns. As members of organized dentistry’s tripartite, it seems appropriate to note any policies that the American Dental Association has established on this topic.

In 2005, the American Dental Association House of Delegates adopted a policy regarding publishing lists that rank dentists. It read, “Resolved, that American Dental Association policy is that any published lists of ‘best dentists’ should incorporate a full disclosure of the selection criteria, including, but not limited to, any direct or indirect financial arrangements.” There is a short mention of the methodology used in the 5280 publication. Our attempt to clarify and verify the accuracy of the selection criteria during our interview with 5280 was unsuccessful. We hope that our upcoming interview with the outsourced company, Top Dentists, will clarify the exact methodology used in forming the 5280 list of dentists.

In a 2006 article in the Journal of the American Dental Association, an ADA member asked whether it was ethical to promote a “best dentist” listing he had recently been awarded. Part of the response references the Principles of Ethics and Code of Professional Conduct (ADA Code)2, “The American Dental Association calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal.” The article continues, saying “So the question to be answered from an ethical standpoint is this: “How will this plaque or selection as a ‘top dentist’ benefit the patient?” By itself, there may be little to no benefit to the patient provided here. The directory is of course a resource listing, which is a convenience for the patient. Benefits can be seen for the dentist, the publisher of the book and the seller of plaques.

Resources that benefit our patients and educate our general public about the dental field must be objective and absent of any conflict of interests. Since the dentist list published by the 5280 magazine is based on subjective criteria (opinion poll by dentists) the actual list in its entirety would likely be considered advertising rather than an objective resource for our Denver Metro patients.

Section 5.F.2 of the American Dental Association Code of Ethics therefore applies to the 5280 list. This section

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on advertising states, “Statements shall be avoided which would a) contain a material misrepresentation of fact, b) omit a fact necessary to make the statement considered as a whole not materially misleading, c) be intended or be likely to create an unjustified expectation about results the dentist can achieve, and d) contain a material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation.”

Further information regarding the American Dental Association’s policies and standards about best dentist lists can be found in the referenced article below, in the ADA Principles of Ethics and Code of Professional Conduct and through other links on the ADA website.

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Articulator – Spring

17

MATERIAL MATTERS The Minimally Invasive Dentistry Umbrella

By Sheldon M. Newman, DDS, MS

T

he concept of minimally invasive dentistry has become an all-inclusive phenomenon that deserves attention, but should not be a justification for unproven technique.

Recently a number of lecturers have tried to redefine caries as a disease of the person that produces lesions. This semantic argument does not change the tools at our disposal nor the effectiveness of their use. Whether there is a claim of a new paradigm or not, our goal as healthcare professionals is to follow the healthcare dictum of, “primum nil nocere,” “first do no harm.”

This guideline leads to the importance of proper diagnosis.

There are multiple diagnostic methods available to dentistry that are non-invasive, but a number are highly subject to artifact, producing false positive signs of disease.1 Dentists are also cautioned on the use of the age-old standby of using the explorer.

Recommendations currently are to use it, but without undue force causing a cavitation. The detection of carious lesions, pre-carious lesions, and white spot lesions is still an area in which dentists must exercise conservative caution.

If non-cavitous lesions are identified, then there are multiple interventions that could be helpful, though still unproven. One such popular treatment is the use of fluoride varnish which is recommended by the ADA for application twice a year, and more often in high risk patients.2 Yet the FDA does not yet recognize this procedure/material as a treatment for caries. Such purpose is an off-label use of the material, subject to professional judgment.3 It seems that political posturing is now impacting recommended practices to a greater extent than the science which supports that practice. Even the long-standing concept of community water fluoridation at 1 ppm as an effective anti-caries methodology is subject to being undermined. Though evidence supports the use of 1 ppm fluoride in the water, the current recommendation, as of 2011, has been reduced to 0.7 ppm.4 If, after careful diagnosis, you are not sure if there is a lesion, do not explore with a bur. The materials do not exist yet to replace enamel. Pit-and-fissure sealants work according to evidence-based review of years of publications.5 If carious lesions are found, how are they to be treated? First, the preparation must be defined. It has been suggested that with adhesives available dentists no longer need to engineer a retentive cavity design. The aggressive preparations originally taught as the principles of G.V. Black are not necessary with current materials, but even the best of adhesives are not perfect for retention, nor are they perfect for sealing. A systematic review of data must rely on the existing data that include laboratory studies and short-term clinical studies. The etch-prime-adhere technique was deemed best but not perfect.6 Therefore, the use of retentive form, such as parallelism of walls, should not be discarded. Though beveling does not appear to add to retention, and extensions may be

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unnecessary, it would be inappropriate to consider a bowl-shaped preparation as mechanically retentive, or providing sufficient bonding area for retention and sealing using chemical adhesives. It is beyond the data that exist to make the often-repeated statement, “Adhesive dental materials make it possible to conserve tooth structure using minimally invasive cavity preparations, because adhesive materials do not require the incorporation of mechanical retention features.”7 Roughening the surface adds surface area and some retentive form is recommended (extrapolating from basic principles and current data). Taking advantage of both mechanical and chemical methods may provide the best solution, but there is insufficient data to prove any of these techniques are clinically better.

Composite is not enamel. A composite restoration is not as good as the whole tooth. The more fluid the material is, i.e. flowable composite, the worse the final properties are. Opening up a fissure in order to place a material is not a proven improvement over the use of a pit-and-fissure sealants. Compromising the restoration by use of inadequate preparation or application of inadequate materials, as advocated today under the guise of minimally invasive dentistry, could lead to more destruction of tooth structure through repeated replacement.

It is imperative to review the literature and especially to keep current with the reviews of the ADA Center for Evidencebased Dentistry,8 where evidence-based and meta-analysis publications are posted and recommendations are made. These recommendations are to be considered in evidence-based decision-making and not just because, “I agree with the statement.”

Dentistry is just beginning to produce some quality data, and analytical techniques of the literature that can help to guide the dentist’s decision making on what the best practices are in minimally invasive dentistry. It is hoped that the conundrums raised here will be thought-provoking.

References: 1. Bader JD, Shugars DA, Bonito AJ; A Systematic Review of the Performance of Methods for Identifying Carious Lesions. Journal of Public Health Dentistry 62:201-13,2002.

2. American Dental Association, Council on Scientific Affairs; Professionally applied topical fluoride, evidence-based clinical recommendations. Journal of the American Dental Association 137:11519,2006.

3. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States, August 2001, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm 4. http://www.hhs.gov/news/press/2011pres/01/20110107a.html 5. Beauchamp J, Caufiled PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R; Evidence-based clinical recommendations for the use of pit-and-fissure sealants. JADA 139:257-68, 2008.

6. Peumans M, Kanumilli P, De Munck J, Van Landuyt K, Lambrechts P, Van Meerbeek B; Clinical effectiveness of contemporary adhesives: a systematic review of current clinical trials. Dent Materials 21:864-81, 2005.

7. Murdoch-Kinch CA, McLean ME; Minimally invasive dentistry. Journal of the American Dental Assocociation 134: 87-95, 2003.

8. http://ebd.ada.org/SystematicReviews.aspx

Articulator – Spring

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EVENT CALENDAR MAY 2012 May 3

Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00 pm - 9:00 pm (303) 488-9700 For more info go to: mddsdentist.com

May 5

UC Denver School of Dental Medicine: FIRST SATURDAY "MORNING NEWS" (2011-2012) "Innovations in Air Polishing: Procedural Solutions for Non-Surgical Periodontal Therapy" Anschutz Medical Campus Aurora, CO 9:00 am to 12:00 pm www.ucdenver.edu

May 9

2011-2012 LAWRENCE H. MESKIN CLINICAL UPDATE SERIES "Oral Manifestations of Systemic Disease" Anschutz Medical Campus Aurora, CO 8:00 am -12:00 pm www.ucdenver.edu

May 12

Metro Denver Dental Society: Cajun Crawfish Boil 12 Mile House Picnic Area, Cherry Creek State Park 4201 South Parker Road Aurora, CO, 80014 11:30 am - 3:00 pm (303) 488-9700 For more info go to: mddsdentist.com

May 17

Metro Denver Dental Society: Annual Meeting & Silent Auction The Brown Palace 321 17th Street Denver CO 80202 6:00 pm - 9:00 pm For more info go to: mddsdentist.com

May 17

D.I.S.C. - Narrower diameter and shorter length implants Dr. John Cavallaro, Prosthodontist Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 5:30 pm to 8:30 pm CE credits are available.

Please call (720) 488-7677 to reserve your place

JUNE 2012 June 2

MDDF Shred Event Metropolitan Denver Dental Society Headquarters Parking Lot 3690 S. Yosemite St., Denver, CO 80237 8:00 am - 12:00 pm (303) 488-9700 For more info go to: mddsdentist.com

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OCTOBER 2012 June 14

October TBD

June 21-24

October 18

Metro Denver Dental Society: New Member Event Location TBD (dates and locations are subject to change) For more info go to: mddsdentist.com Metro Denver Dental Society: Weekend Get-Away Devil’s Thumb Ranch 3530 County Road 83 Tabernash, CO 80478 For more info go to: mddsdentist.com

AUGUST 2012 August 16

Metro Denver Dental Society: New Member Event Amato’s Ale House, Denver, CO (dates and locations are subject to change) For more info go to: mddsdentist.com

August 18

MDDS Night with the Rockies Coors Field 2001 Blake Street Denver, Colorado 80205 Dinner at 4:30 pm and Game at 6:10 pm (303) 488-9700 For more info go to: mddsdentist.com

August 21

Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00 pm - 9:00 pm (303) 488-9700 For more info go to: mddsdentist.com

September 2012 September 14

Metro Denver Dental Society: Negotiating Office Leases and Purchases Capitalizing on the Current Market Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 9:00 am - 12:00 pm For more info go to: mddsdentist.com

September 19

Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00 pm - 9:00 pm (303) 488-9700 For more info go to: mddsdentist.com

Metro Denver Dental Society: New Member Event Location TBD (dates and locations are subject to change) For more info go to: mddsdentist.com Metro Denver Dental Society: CPR & AED Training, a Two-Year Certificate Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 6:00 pm - 9:00 pm (303) 488-9700 For more info go to: mddsdentist.com

NOVEMBER 2012 November TBD

Metro Denver Dental Society: Sleep Medicine - Dr. Barry Glassman Time TBD Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 (303) 488-9700 For more info go to: mddsdentist.com

November 3

Metro Denver Dental Society: Behavior Management Strategies in Pediatric Dentistry with Special Consideration of Medical Immobilization - Dr. Ulrich Klein Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time TBD (303) 488-9700 For more info go to: mddsdentist.com

DECEMBER 2012 December TBD

Metro Denver Dental Society: Nitrous Oxide/Oxygen Administration Training Dr. Gerome Green Metropolitan Denver Dental Society Headquarters 3690 S. Yosemite St., Denver, CO 80237 Time TBD (303) 488-9700 For more info go to: mddsdentist.com

JANUARY 2013 January 24-26

Metro Denver Dental Society: 2013 Rocky Mountain Dental Convention Colorado Convention Center (303) 488-9700 For more info go to: rmdconline.com (dates and locations are subject to change)

Articulator – Spring

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PRACTICE MANAGEMENT Employee Bonuses

by Paul Pavlik

A

“bonus” is defined as “something given or paid in addition to what is usual or expected.”

Is a Bonus System Appropriate for Your Practice?

Before you blindly issue employee bonuses, you should have a solid foundation in understanding your finances. This is done by regularly tracking your production, revenue and expenses (an advisor can tell you how to track your finances and analyze your progress). Then, you must determine whether the idea of bonuses is appropriate and whether the additional expense associated with bonuses is affordable.

If You Decide to Offer Bonuses, What Should You Consider?

Since extra money can be a powerful motivator if offered under the right circumstances, let’s assume you have concluded that all of the criteria mentioned above have been met, and that you still want to set up an additional reward system to show how much you appreciate their efforts. Then consider:

How Often Should Bonuses Be Given?

Many doctors believe that monthly bonuses are the norm. We strongly recommend, however, that you consider quarterly or annual bonuses instead.

Why are you even considering a bonus system? If you think bonuses might energize employees to turn a poor cash flow to a positive one, or if you want to increase their pay in hopes it will improve performance, you are looking at the wrong solution.

If employees know, in advance, that you expect their best efforts all of the time, why is a bonus even necessary? If your current employees don’t agree, reevaluate your choice of employees.

You must let your employees know what their targets are, give them the education and tools to do their job, measure and share their performance with them, pay them appropriately, allow them autonomy to make recommendations, trust their skills and show them they are appreciated. If you can provide that, you will get performance, commitment and loyalty. These actions will lead to personal fulfillment and job satisfaction.

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Method: If your production goal for the past month was $100,000, the bonus is based on each employee receiving a share of a pre-specified percentage (e.g., 20%) on any production above the monthly goal.

Therefore, if production for the last month was $110,000, employees would split 20% of $10,000 (the amount over the goal) or $2,000. With five employees, each employee’s bonus would be $400.

Cons: Basing bonuses strictly on production has its caveats. Aggressively pushing treatment becomes the driving force, and it is usually done by the clinical staff who fully understands the treatment but are not involved in collections. The incentive to collect may be neglected by front desk personnel since production, not collecting for services, is the basis for bonuses. In addition, overselling may occur; this has the same unwanted effect as overzealous collection tactics; it turns patients off.

What Are Your Goals?

Bonuses are traditionally used as a reward for what has been delivered and achieved. Past performance, however, does not necessarily predict future performance. If we are actually seeking to ensure that we reward employees for the work they do and motivate them to higher performance levels, then we need to draw on the research already available for recommendations. Research consistently indicates that as long as you pay people a fair salary, you will not gain any further performance benefit by paying them bonuses. (I recommend you view an intriguing animated clip which describes this research further at http://tinyurl.com/2ga47re.)

treatment that you have recommended in order to qualify for a bonus. The greater the number of people involved in encouraging treatment usually gives the patient the confidence that the treatment does, in fact, have merit. In addition, without increasing production, revenue will not increase.

2. Basing Bonuses on Revenues If your practice is like most, it experiences random months that show flat or negative cash flows. If you give monthly bonuses based on previous months’ performances, the funds may not be available in the month that you have to write the bonus checks.

How Can Bonus Systems Be Structured?

Bonuses can be based on cash incentives (e.g., check, debit card), gifts (e.g., iPad, watch), or time rewards (e.g., additional paid time off). Since most practices use bonuses based on cash, our examples include the pros and cons of different cash bonus systems and how each method is structured. (The percentage of 20%, used in the following examples, is hypothetical; actual percentages typically vary from 1% to 20%.) It is recommended that all employees (i.e., the team approach) should equally share in the profits.

1. Basing Bonuses on Production Pros: Production-based bonuses look good since your employees will be encouraged to promote

Pros: Since Revenue is the only place to find the funds to pay expenses, basing a bonus plan on increasing revenue may seem like the best approach.

Method: This is similar to the above production example. If revenue for the last month was $110,000, the employees would split 20% of the amount over the $100,000 goal.

Cons: Beware. Those employees responsible for collections may become overly aggressive in their collection tactics and alienate patients. In addition, the clinical staff will have no incentive to promote timely collections since they are not typically involved in that. If scheduling for production takes second place to revenue, production will, given time, fall off and revenue will eventually dry up.

3. Basing Bonuses on a Compromise Pros: Since expenses are paid with revenue, and since revenue comes from production, it may be prudent to consider a combination of both systems. All staff will become involved in both encouraging recommended treatment and collecting on that treatment. Everyone, including you, will share the rewards.

Articulator – Spring

Method: First, establish a production goal. This guarantees that your employees will encourage treatment. Now, assuming you surpass the production goal, the revenue goal must also have been exceeded. Then, base the bonus on each employee receiving a share of a pre-specified percentage on any revenue dollars received above the revenue goal (see examples above) since revenue is what pays the bonuses, Be sure to emphasize that production gains should always coincide with or exceed revenue.

Cons: None. Since everyone has to be involved for success to receive a bonus, treatment is encouraged and therefore overall production increases and subsequently, revenue increases.

How Should You Prepare Your Staff?

The following recommendations apply to whether you are using a bonus system or not. Have a meeting with your staff and set goals. These goals should be concrete, attainable, and critical to the growth of your practice.

1. Always set goals with employees: They are often the best source for information about what will contribute to increased productivity and service.

2. Reevaluate goals frequently: Do this, at a minimum, once per month.

3. Make goals specific and measurable: Instruct employees in exactly what you expect and what steps they might take. Then, measure their success and share it with them.

4. Set goals that tie into the success of your practice: Don't automatically assume that goals should be tied to increased production or profitability.

Consider cutting expenses or improving customer service.

5. Goals must be attainable: Goals that are too high lead to employee frustration and demotivation.

Conclusion There is no doubt that money is a tremendous motivator, so start by paying employees fairly. Remember, however, what motivates us – it’s praise from others. Give your employees the freedom to experience praise.

Don't hesitate to pay them well, give bonuses when appropriate and, most importantly, give them the gifts of knowing they contribute and then thanking them frequently for their efforts.

Dr. Paul J. Pavlik is the founder and president of Tracker Enterprises, Inc., a practice management think tank and transition resource for dentists.

His experience includes over 35 years as a successful dentist, practice sales and transitions facilitator, practice management coach, speaker, author and researcher. He is available for questions or comments on this or other practice management subjects at 719-592-0878 or email him www.pjp@ trackerenterprises.com. For more practice management tips, he welcomes you to visit his website at trackerenterprises.com and participate in his blogs.

The Free Online Dictionary, www.thefreedictionary.com/bonus RSAnimate, adapted from Daniel Pink, Drive, The Surprising Truth About What Motivates Us, Riverhead Books, 2011 3 AMEX Small Business Network, http://www.smetoolkit.org/smetoolkit/en/content/ en/305/Bonuses-How-To-Be-Fair 1 2

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th

Annual

Meeting

Silent Auction & Society Dinner

Join us for an enjoyable evening honoring MDDS incoming president, Dr. D. Diane Fuller, the 2012-2013 Executive Officers and Board of Directors. Highlighting the event will be a silent auction with all proceeds benefitting the Metropolitan Denver Dental Foundation and an awards ceremony recognizing your colleagues for their outstanding community service and Society volunteerism.

Schedule of Events 5:30 pm - 6:00 pm Historic Brown Palace Tour

(you must sign up ahead of time)

6:00 pm - 7:00 pm Wine Tasting & Silent Auction 7:00 pm - 8:00 pm Dinner 8:00 pm - 9:00 pm Installation and Award Ceremony

Event Location The Brown Palace Hotel 321 17th Street, Denver, CO 80202

Attire

Business (Black Tie Optional)

Price

$85 for attendees and guests $42.50 for Past Presidents

Please register online by May 10, 2012 at mddsdentist.com Interested parties who would like to stay downtown, The Brown Palace Hotel is offering a special rate of $199/night for attendees.

To donate an item to the silent auction please email darneson@mddsdentist.com.

Articulator – Spring

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NON-PROFIT NEWS Don't Miss Out on this Year's MDDF Shred Event!

By Amy Boymel, MDDF Executive Director

Dr. Friedman brings in a nutritionist for each of the GKAS patients to consult with after their visit

MDDF can help you go from this…......... to this!

G

ot stacks (and stacks) of old patient records & x-rays or personal papers you no longer need? MDDF can help you destroy them safely and securely. It’s easy! And as an MDDS member dentist recently said, “MDDF’s Shred Event is a great MDDS member benefit!”

Join us for MDDF’s Annual Shred Event, Saturday, June 2, 2012.

Shredding trucks will set-up in the MDDS parking lot (3690 South Yosemite Street) from 8:00 am to 12:00 pm. Each “banker-sized box” is just $7 to shred; larger boxes are $12, payable on-site by cash, check (payable to MDDF) or credit card. 100% of the proceeds benefit MDDF.

Dr. Karen Foster demonstrating flossing techniques for a three-year-old at her Aurora practice

Toy chest time!

Cornerstone Records Management will provide the Shredding trucks and BVB General Contractors will provide the treats!

Can’t be here on June 2? We can still help. Cornerstone Records Management has graciously offered to extend a discount to MDDS members for both one-time and monthly home or office shredding services. For a low one-time rate of $59 you can shred up to 300 lbs. (about 10 boxes) or choose monthly ongoing shredding services starting at just $35 per month. Please call Cornerstone directly at 303-307-9890 to make arrangements for either service. Be sure to tell them you’re an MDDS member to qualify for discounted rates.

Whichever option you choose, you get a great deal on a valuable service and you help MDDF at the same time. And if you join us on June 2 we’ll even give you a cup of coffee!

Have a question? Please contact Amy Boymel at aboymel@mddf.org or 303-957-3272.

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Dr. Mitchell Friedman seeing one patient out of a family of nine that trekked the snow to his Lafayette office on GKAS day

Come Snow, Come GKAS! While an epic snow storm made transportation nearly impossible, dentists still welcomed little patients on Give Kids a Smile Day. Even though the University of Colorado School of Dental Medicine, the largest site, was unable to open its doors in the wake of the storm, over 1,000 kids were still treated!

Articulator – Spring

PRACTICE MANAGEMENT Why is so Much Attention Given to Rate of Return

By Daniel C. Flanscha, CFP®, CLU, ChFC - President, Longs Peak Financial

I

am always amazed, how much emphasis in America is placed on investment rate of return. In this article we are going to explore the difference between average rate of return(s) (R.O.R.) and actual R.O.R. and discuss how any financial plan based on R.O.R. assumptions can lead to a false sense of security and potentially to financial disappointment and financial insecurity.

We begin with a simple example and grossly exaggerated R.O.R. to make a point. For this example assume you invested $100,000 and the first year you doubled your money (+100% R.O.R.). At the end of the first year you had $200,000 in your account. The second year you lost 50% (-50%) so you ended up with $100,000. The third year you doubled your money again (+100% R.O.R.) and end the year with $200,000. The fourth year you again lose 50% (-50%) finishing the year back with an account valued at $100,000. What was your actual rate of return? It is easy to see that it is zero. Now let us look what your average R.O.R. was: 100 + 100 [two positive years] – 50 – 50 [two negative years] = 100 / 4 years = 25% Average R.O.R. One is prompted to ask: Why are financial institutions allowed to market on the basis of average R.O.R.?

Are you upset yet?

Let’s take a look at a real time period and compare “average” versus “actual” R.O.R. If you had invested a consistent amount of money at the beginning of each year for 10 years starting in 1995 in large company stocks (based on the S&P 500), at the end of the ninth year your average R.O.R would have been 14.00%, but your actual R.O.R. would have only been 7.52%. To be fair, the actual R.O.R. is not always lower than the average R.O.R. To further demonstrate I will share with you another example. If you had made the same investments in the previous example but started in the year 2000, by the end of the 9th year (end of 2009) your average R.O.R. would have been 1.21% and your actual R.O.R. would have been 1.33%.

Obviously the actual R.O.R. can turn out to be higher than the average.

What happens when you apply this in a method that traditional financial planning uses – linear math? Suppose you visit with a financial planner/banker/investment sales person and they tell you: if you invest $10,000 per year and receive an average of 14.00% at the end of 20 years you would have $910,000. You may feel satisfied, secure and at peace knowing you will have close to a million dollars in net worth. But what if in reality you only

26

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receive an actual R.O.R. of 7.52%? If this were so, the reality is your account would be worth just under $467,000. There is a BIG difference between $910,000 and $467,000! So what are you basing your financial decisions on? In the second example, if your actual R.O.R. had been 1.33% your account would have been worth $227,000. So I repeat – Why are we paying so much attention to R.O.R. and why are we basing retirement aspirations and serious financial decisions on them?

I believe there are several reasons. First, it is easy to apply mathematical assumptions to money to arrive at conclusions.

Secondly, I believe deep down human nature tends to be a little greedy. We often think we will be the one who actually earns the 14% R.O.R. It is no wonder so many are disappointed and become disenchanted with what they have been doing financially over the past couple of decades.

So what is the solution? First, I believe it is important to use R.O.R. assumptions in our planning that are more realistic.

Secondly, I believe the past decade has taught us that saving may be as important as investing. This is a truth that was known in the past but often ignored, when we thought the stock market would promise us double digit R.O.R. Unfortunately, as a general rule, I don’t think we understand anymore the difference between saving and investing. Many people think they are saving when the reality is they are investing and there is a BIG difference between these too. Finally, I believe it is important for each of us to spend more time and energy studying planning options.

From a macro economic perspective other issues such as: lost opportunity costs, the velocity of money, long term tax efficiencies and the coordination and integration of financial moves must be considered. Those things go beyond the scope of this article but it is through the consideration of these things that we can begin to potentially achieve better results with even less risk than we would if we were depending on R.O.R. The next time you hear someone begin to share with you an example regarding money using some sort of R.O.R. assumption, you will at least be able to take note and begin to evaluate the scenario from a different perspective. Based on personal experience it will not take long for you to observe a situation in which R.O.R. is utilized to justify some future number. Just turn on the television or radio or pick up some sort of publication.

My guess is you won’t make it through the day without seeing or hearing something.

Articulator – Spring

BACK TO SCHOOL School of Dental Medicine Hosts 28th Annual Research Day

By Catherine Freeland

M

ore than 200 dental students, residents and faculty participated in the 28th Annual University of Colorado School of Dental Medicine’s (SODM) Annual Research Day Scientific Program on the Anschutz Medical Campus.

The day featured highlights from both basic science and clinical research. Oral presentations were made by faculty, residents and dental students. The day concluded with 25 poster presentations by students and residents.

Dean Denise Kassebaum, DDS, MS, introduced the day to the attendees. "Research Day provides the opportunity to highlight current research activities of faculty, students, residents and post-docs, and to stimulate new projects through the sharing of information that goes on."

The keynote presentation was made by new SODM faculty member, Clifton Carey, PhD, who joined the dental school faculty in November, 2011. He was previously the Director of Independent Research and Grants Administration at the American Dental Association Foundation’s Paffenbarger Research Center.

Deise Oliveira, DDS, MS, a clinical faculty member in the Department of Restorative Dentistry, presented her research on attitudes toward “Minimally Invasive Dentistry among General Practitioners.”

In addition to the faculty presentations, three student researchers presented their research to their colleagues. First-year student, Petros Yoon, outlined his research in the lab of Lynn Heasley, PhD, on head and neck cancer cells, and a potential specific treatment.

Dr. Moataz Elkasrawy, a student in the International Student Program, discussed his research with Sheldon Newman, DDS, MS, on “Experimental BPA-Free Orthodontic Bracket Adhesives or Amorphous Calcium Phosphate Containing.” The focus of Jordan Lamberton, DDS, a resident in the orthodontic program, was on his clinical research study, “Perception of Pain during Miniscrew Placement: Compound Topical Versus Injection.”

Carey’s presentation: “Why? Because…Why? – Questioning the Status Quo, Changing the Future: Fluoride Examples,” was built on his vast experience as a R01 funded researcher, especially in the area of caries research.

The dental and ISP students who presented posters or oral presentations were eligible to win sponsored trips to regional or national meetings. Dr. Moataz Elkasrawy won a trip to the American Dental Association meeting this fall in San Francisco, to participate in the ADA/Dentsply Student Research Competition, against students from all of the dental schools in the country. Kip Sterling, a 3rd-year dental student, working with Donald Kleier, DDS, MS, on rotary file systems, will represent the school at the Hinman Student Research Symposium in Memphis, Tennessee, this fall.

“Any research project begins with a question. Questions such as ‘why?’ can lead to a lifetime of looking for answers,” Carey said.

“The question is often the easiest part of the project.”

The SODM Research Day was organized by Sheldon Newman, DDS, president of the Colorado Section of the American Association of Dental Research.

Left to right, Sheldon Newman, DDS; Denise Kassebaum, DDS, MS; Deise Oliveira, DDS, MS; Jeff Stansbury, PhD; and Clif Carey, PhD

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mddsdentist.com

Articulator – Spring

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CLASSIFIEDS DENTAL ASSISTANT Offering an excellent opportunity for an experienced and motivated applicant. Our office is located in South Littleton/Highlands Ranch area. This progressive, two-dentist general practice may be the place for you. Salary will be commensurate with experience and talent.

Immediate opening available for a part to full-time position (Tues – Fri). Please fax your resume to Grout Family dentistry at (303) 730-2096; or e-mail to info@ groutfamilydentisty.com. We look forward to meeting you.

Associate Positions: Please visit our website www.ctc-associates.com to see the current associate opportunities available. To apply, email your resume and cover letter to info@ ctc-associates.com. Please specify which location you are applying for and when you are available to start.

Transition Services: For more information on how to sell your practice or bring in an associate, please contact Larry Chatterley or Susannah Hazelrigg with CTC Associates at (303)795-8800 or visit our website for practice transition information and current practice opportunities www.ctc-associates.com.

PRACTICES FOR SALE: New Listings Available for 2012! Northern Colorado…

Southern Colorado…Western Colorado and Metro Denver! SEE ADS at www.sastransitions.com Inventory changes fast! Call or contact me today for specific information. Susan Spear, Transition Specialist / Licensed Broker, SAS Transitions, Inc. SAS Dental Practice Brokers 303.973.2147 susan@sastransitions.com General Practices for Sale: Practice listings along the Front Range in Denver, Lakewood, Lafayette, Centennial, Fort Collins, Lamar, Weld County Garfield County and Eagle County. For more information on current practice opportunities, including an overview of each practice, please visit our website www.ctc-associates.com or call Larry Chatterley or Susannah Hazelrigg with CTC Associates at (303)795-8800.

Bonnie Brea Dental Office For Lease 1,809 SF, beautiful finishes, 2 treatment opts with 1 over sized hygiene opt, room for expansion, great visibility, Must See! Jamie Mitchell, jmitchell@shamesmakovsky.com, 303-565-3041 Hire me to SELL your practice! Choose a Broker You Can Trust! I get results! Ask your friends! I find the BEST Buyers and make you proud of your decision! Direct Sales! Associate to Partnerships! Associate Buy-outs! 17 Years Experience in Dental Practice Transitions! Susan Spear, Practice Transition Specialist / Licensed Broker SAS Transitions, Inc. SAS Dental Practice Brokers 303.973.2147 susan@sastransitions.com Pediatric Dental Practice: South Denver, 3 ops, grossing $239,000. For more information, please visit www.ctc-associates. com or call Larry Chatterley or Susannah Hazelrigg at (303)795-8800.

DENTAL OFFICE SPACE Arvada / Westminster, 1 story professional building complex. 1,100 sq. ft. professional office.

Fronted by busy Old Chicago restaurant and adjacent professional massage therapy practice. Modern, well designed and attractive unit with 4 Tx rooms dental equipment installation ready with cabinetry, gas lines, plumbing, electrical in place.

Plenty of storage & Dr. private office with private entrance. Great drive-by & walk-by exposure with ample dedicated parking.

New carpet tenant finish allowance.

Contact: Jim True at 303-425-9200

Enter the digital age for less cost! Both of these items are in perfect condition, uptodate servicing and available only because I have upgraded and consolidated equipment.

PlanMeca Digital Pro Max Panograph with Tomography features. Best machine on the market, easily upgradable to 3D CBCT. Also, newer CEREC Acquisition Scanner/ CPU and all current software, Compact Milling unit and many accessories. Call Lori or Ann-Marie at Dr. Carpenter's office, 303- 427-4120.

For Sale: MiniCam Plus Intraoral Camera with white cart and Sharp monitor. $350 works perfectly and looks like new. Please call 303-617-5212. Aurora, CO Micro-Etcher (Danville) needed. Used, good condition. Kids In Need of Dentistry, 303-733-3710 ext. 17

Buyer Representation: If you would like more information on buying a practice or associating before a buy-in or buy-out, call CTC Associates at (303)795-8800 or email info@ctc-associates.com.

Start-up/Practice Management: For more information on doing a scratch start-up or assistance with managing your practice, call Marie Chatterley at (720)219-4766 or email marie@ctc-associates.com.

BEST CARD IS PROUD TO BE THE CREDIT CARD PROCESSOR OF THE METROPOLITAN DENVER DENTAL SOCIETY AND THOUSANDS OF DENTISTS WHO SAVE AN AVERAGE 23%/YEAR

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To receive a free cost comparison and a $5 Starbucks® Gift Card or call 877.739.3952

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Need Help BUYING a Practice? Help with Appraisals, Reports, Financing and More!

I provide expert advice on how to Purchase Your Practice, Negotiate on your behalf, and help you successfully become the New Owner! Why go it alone? Fair fees without risk! Susan Spear, Practice Transition Specialist / Licensed Broker SAS Transitions, Inc. SAS Dental Practice Brokers 303.973.2147 susan@sastransitions.com

Advertise with US! Market your business to the Metro Denver dental profession!

For more details visit mddsdentist.com or contact Jason Mauterer at jmauterer@mddsdentist.com or call 303.488.9700 x3270 Download the ad kit at this address mddsdentist.com/articulator/advertising.asp

“C

hristian and Colin helped us negotiate a fantastic lease extension and saved us a ton of money!”

Michael Burnham, DDS Burnham Oral Surgery

At Carr Healthcare Realty…

Colin Carr President

303.817.6654 colin@carrhr.com

Christian Gile Principal Denver Metro

303.960.4072 christian@carrhr.com

We provide dentists with the most experienced representation and skilled negotiating available for every real estate need.

Roger Hernandez

Whether you are purchasing, relocating, opening a new office, or renewing your existing lease, we’ll make sure you receive the most favorable price, terms and concessions possible.

719.339.9007 roger@carrhr.com

Every transaction is unique and provides substantial opportunities on which to capitalize. The slightest difference in the financial and legal terms negotiated in every lease or purchase can impact your practice by hundreds of thousands of dollars! With this much at stake, expert representation and skilled negotiating are essential to receive the most favorable terms.

Colorado Springs Southern Colorado

Kevin Schutz

Boulder • Northern Colorado Western Slope • Wyoming 970.690.5869 kevin@carrhr.com

If your lease is expiring in the next 12 – 18 months, allow us to show you how we can help you negotiate the most favorable lease or purchase possible.

Lease Negotiations • Office Relocations • Lease Renewals • Purchases