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TEXAS DENTAL JOURNAL Established February 1883

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Vol 131, No 4

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April 2014

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297 ABOUT THE COVER

The advancement of dental implants has changed the way denti ts approach oral rehabilitation. Read more about how dental implants have evolved in the case study on page 303.

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TDA GOVERNANCE: CANDIDATES FORUM UNUSUAL RADIOGRAPHIC FINDING DURING ROUTINE PERIODONTAL MAINTENANCE: A CASE REPORT Ahmed El-Halaby, DDS, MSD and Michel V. Furtado Araújo, DDS, MSc, MDS The authors present a case report describing the presence of radiopaque artifact appearing in multiple intraoral periapical and bitewing radiographs during routine periodontal maintenance in an edentulous area with a history of ridge preservation procedure.

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DIGITAL DENTISTRY AND IMPLANT DENTISTRY: A CASE REPORT Richard Zimmermann, DDS; Stefanie Seitz, DDS; and Donald Nyugen The authors present a case study on the advances in denti try, changing the way denti ts approach implant denti try.

MONTHLYFEATURES 284

President’s Message

312

Oral and Maxillofacial Pathology Case

292

Oral and Maxillofacial Pathology Case

of the Month Diagnosis and Management

of the Month

314

Calendar of Events

296

Criti ally Appraised Topic of the Month

316

2013 TDA Annual Session TEXAS

317

In Memoriam

317

Memorial and Honorarium Donors

317

Advertisin Briefs

310

Value For Your Profession

334

Index to Advertise s

280

Texas Dental Journal l www.tda.org l April 2014

Meetin Photo Contest Winner

TDA members, use your smartphone to scan this QR Code and access the online Texas Dental Journal.


Editorial Staff

Editorial Advisory Board

BOARD OF DIRECTORS TEXAS DENTAL ASSOCIATION

Daniel L. Jones, DDS, PhD, Interim Editor Harvey P. Kessler, DDS, MS, Associate Editor Nicole Scott Managing Editor Barbara Donovan, Art Director Paul H. Schlesinger, Consultant

Ronald C. Auvenshine, DDS, PhD Barry K. Bartee, DDS, MD Patricia L. Blanton, DDS, PhD William C. Bone, DDS Phillip M. Campbell, DDS, MSD Michaell A. Huber, DDS Arthur H. Jeske, DMD, PhD Larry D. Jones, DDS Paul A. Kennedy Jr, DDS, MS Sco R. Makins, DDS Daniel Perez, DDS William F. Wathen, DMD Robert C. White, DDS Leighton A. Wier, DDS Douglas B. Willingham, DDS

The Texas Dental Journal is a peer-reviewed publication Texas Dental Associatio 1946 S IH-35 Ste 400, Austin TX 78704-3698 Phone: 512-443-3675 • FAX: 512-443-3031 E-mail: tda@tda.org • Website: tda.org Texas Dental Journal (ISSN 0040-4284) is published monthly, one issue will be a directory issue, by the Texas Dental Association 1946 S IH-35, Austin TX, 78704-3698, 512-443-3675. Periodicals Postage Paid at Austin Texas and at additiona mailing offi s. POSTMASTER: Send address changes to TEXAS DENTAL JOURNAL, 1946 S IH 35, Austin TX 78704. Copyright 2014 Texas Dental Asociation All rights reserved. Annual subscriptions: Texas Dental Associatio members $17. In-state ADA Affil ted $49.50 + tax, Out-ofstate ADA Affil ted $49.50. In-state Non-ADA Affil ted $82.50 + tax, Out-of-state Non-ADA Affil ted $82.50. Single issue price: $6 ADA Affil ted, $17 Non-ADA Affil ted, September issue $17 ADA Affil ted, $65 NonADA Affil ted. For in-state orders, add 8.25% sales tax. Contributions: Manuscripts and news items of interest to the membership of the society are solicited. Electronic submissions are required. Manuscripts should be typewri en, double spaced, and the original copy should be submi ed. For more information please refer to the Instruction for Contributors statement printed in the September Annual Membership Directory or on the TDA website: tda.org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association unless such statements have been adopted by the Association Article are accepted with the understanding that they have not been published previously. Authors must disclose any financia or other interests they may have in products or services described in their articles Advertisements: Publicatio of advertis ments in this journal does not constitu e a guarantee or endorsement by the Associatio of the quality of value of such product or of the claims made of it by Texas Dental Journal is a member of the its manufacturer. American Associatio of Dental Editors. Member Publication

PRESIDENT David A. Duncan, DDS 806-355-7401, davidduncandds@gmail.com PRESIDENT-ELECT David H. McCarley, DDS 972-562-0767, drdavid@mccarleydental.com IMMEDIATE PAST PRESIDENT Michael L. Stuart, DDS 972-226-6655, mstuartdds@sbcglobal.net VICE PRESIDENT, NORTHWEST David C. Woodburn, DDS 806-358-7471, olddave1@gmail.com VICE PRESIDENT, NORTHEAST Jean E. Bainbridge, DDS 214-388-4453, jbainbridgedds@sbcglobal.net VICE PRESIDENT, SOUTHEAST Gregory K. Oelfke DDS 713-988-0492, greg@oelfk .com VICE PRESIDENT, SOUTHWEST Yvonne E. Maldonado, DDS 915-855-2337, yvonnedent2000@yahoo.com SENIOR DIRECTOR, NORTHWEST Steven J. Hill, DDS 806-783-8837, sjhilldds@aol.com SENIOR DIRECTOR, NORTHEAST Jerry J. Hopson, DDS 903-583-5715, dochop@verizon.net SENIOR DIRECTOR, SOUTHEAST William S. Nantz, DDS 409-866-7498, wn3798@sbcglobal.net SENIOR DIRECTOR, SOUTHWEST Joshua A. Austin DDS 210-408-7999, jaustindds@me. om DIRECTOR, NORTHWEST Charles W. Miller, DDS 817-572-4497, cwdam@sbcglobal.net DIRECTOR, NORTHEAST William H. Gerlach, DDS 972-964-1855, drbill@gerlachdental.com DIRECTOR, SOUTHEAST Karen A. Walters, DDS 713-790-1111, kwalters@sms-houston.com DIRECTOR, SOUTHWEST John B. Mason, DDS 361-854-3159, jbmasondds@aol.com SECRETARY-TREASURER Ron Collins, DDS 281-983-5677, roncollinsdds@yahoo.com SPEAKER OF THE HOUSE John W. Baucum III, DDS 361-855-3900, jbaucum3@msn.com PARLIAMENTARIAN Michael Vaclav, DDS 806-355-7463, drvaclav@suddenlinkmail.com INTERIM EXECUTIVE DIRECTOR Michael L. Stuart, DDS 512-443-3675, mstuartdds@sbcglobal.net LEGAL COUNSEL Mr William H. Bingham 512-495-6000, bbingham@mcginnislaw.com

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Faces you Know, Names you Trust. Kathleen Hamilton, DDS, MBA, CMEA Joel C. Small, DDS, MBA, FICD Lynne Gerlach, DDS, FICD, FACD

(800) 988-3969 Toll Free www.hamiltonsmall.com

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President’s Message President’s Message

David Duncan, DDS, TDA President David Duncan, DDS, TDA TEXAS President I’m preparing for the Meeting.

Thank you for the opportunity to to come represent you this year. I have enjoyed the hospitality you have shown me over the year and I have actually enjoyed tackling the issues placed before us.

Physically, I’m getting y office ready to be closed for several days, travel to San Antonio, and a end the biggest dental meeting in Texas. In addition to the CE opportunities and the visits with vendors at the exhibit hall, I’ll catch up with colleagues, to come old and new, and participate in some really neat events – the New Denti t Party, the International College of Denti ts/American College of Denti ts Breakfast, the Texas Party, and the TDA Smiles Foundation Healthy Smiles Golf Tournament. Mentally, I’m getting eady to participate in the House of Delegates, the governing body of the Association. With the leadership of Speaker of the House Dr John Baucum, these volunteer members of the Board of Directors, delegates and alternate delegates, and student delegates will go through resolutions dealing with policy, administration, and the business of the Association. It is very important work. Sometimes interesting and sometimes tedious, but important, nonetheless. And, I’m proud to be a part of it. I’m also preparing to wrap up my presidency. This has been quite the experience when you consider the amount of traveling we have done, the pension plan issue, the executi e director search, Perks, and some personal health issues. I look forward to a bright future for TDA under the leadership of Mr Mike Geeslin as our new executi e director and would like to commend the search commi ee and the board for their hard work and diligence in choosing the director. I am thankful for Mr Bingham and his wise counsel when it came to navigating the waters with all the legal issues that can surround things such as the pension plan recovery process and the Perks/Supplies program. I would also like to thank and applaud the staff for the way they have conducted themselves and business through a somewhat difficult year. I am proud to tell you that TDA is in excellent hands when it comes to our sta . It was business as usual and we did not miss a beat. We are lucky to have all of them. In closing, thank you for the opportunity to represent you this year. I have enjoyed the hospitality you have shown me over the year and I have actually enjoyed tackling the issues placed before us. Only time will tell what the final outcome will look like. I am grateful for all of you that have made yourself a part of this association. It is your association and you should be proud to be a member.

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Candidates Forum — Editor

E

very year, in accordance with the Bylaws, the TDA House of Delegates elects the offic s, directors, and council members of the Associatio for the coming year. Candidates for council position are nominated by the president-elect, and candidates for directorship are nominated by their respecti e division caucuses. Three offic are considered “at large” offic as their nominatio is not restricted; as long as they meet the qualifi ation for offic they can be nominated by an individual, by a component, or by the Board of Directors if no nominatio has been received for that offi by the winter meetin of the Board. These offic are the secretary-treasurer, the editor, and the speaker of the House of Delegates. Every third year, the president-elect is an at-large offic This year, one new outstanding individual is seeking the opportunity to fil the editor position Dr Daniel L. Jones of Dallas. The following essay explains his qualifi ation and interests.

Daniel L. Jones, DDS I appreciate this opportunity to tell you about myself and why I am interested in the positio of editor of the Texas Dental Journal (TDJ). It has been an honor for me to serve as interim editor of the TDJ for the past several months. Unfortunately, this was occasioned by the untimel passing of our colleague and friend, Dr Steve Ma eson. It was at his invitatio that I became an associate editor of the TDJ in 2012. I felt compelled to o er my assistance as interim editor, by way of continuin his legacy of service and excellence in managing the publication Jones

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As my career in dental educatio is now entering a fourth decade, spent at 2 of the 3 Texas schools (University of Texas Health Science Center at San Antonio Dental School and Texas A&M University Baylor College of Denti try), I expect


that many of you may remember me (without undue rancor, I hope) from one class or another, one school or another. It has been grati ying for me to see so many new young graduates join our profession over the past 30+ years. It has also been my pleasure to work in the arena of professional journals and publicatio during this time I began, as most in academia do, as an author submitti manuscripts for publication Over the years, I have published papers on topics as diverse as neuropharmacology in an animal model to the osseointegratio of dental implants, with stops along the way to examine latex sensitivit in clinicians and patie ts, and techniques for assessing inferior alveolar nerve function I’ve served as a reviewer for the Journal of the American Dental Associatio , the Journal of Oral and Maxillofacial Surgery, the Journal of Dental Research, the Journal of Dental Educatio , the American Journal of Denti try and of course, the Texas Dental Journal. My fi st editorial experience came in the form of a special issue of the Texas Dental Journal dealing with oral cancer, fi st published in 1996. That issue began a tradition the most recent example of which you will see in May of this year. Shortly a er that fi st issue of the Journal, I became editor of the Oral

Disease Update, the newsle er of the Dental Oncology Educatio Program (DOEP), which was distributed to denti ts and dental hygienists in Texas. Also under the banner of the DOEP, I’ve helped edit 3 edition of the monograph Oral Health in Cancer Therapy: A Guide for Health Care Professionals. The monograph was part of the continuin educatio programs o ered by the DOEP in Texas, and has been quite well received on a nationa level as well. It has also been my privilege to work with our professional organization on many levels. I fi st served on an American Dental Associatio Nationa Board Test Constructio Commi ee in 1994 and have been on various Test Constructio Commi ees every year for the past 14 years. At the state level, one of the accomplishments I am most proud of is partnering with Drs Bill Gerlach and Larry Herwig in 2004 to organize the rst TDA Smiles Foundation Mission of Mercy in the Dallas area. Addressing the issue of access to oral care for the underserved has become one of my primary interests, both as an educator and as a clinician. In closing, I want to say that my goal as editor of the Texas Dental Journal

will be to continu the standard of scienti rigor and interest to readers established by Dr Ma eson and a ract the best and most informa ve submissions from authors in Texas and outside the state. We are one of the largest and most populous states in the nation with outstanding institutio of dental educatio as well as competent, professional, and caring dental clinicians. I promise to strive to the best of my ability to produce a professional journal that is also of the highest quality.

Personal information • Married 35 years to Camille, a physical therapist practicin in Dallas. • Three sons: Eric, a Marine veteran; Andrew, a 2006 graduate of Austi College; Alex, a 2011 graduate of the University of Texas at Austin • Grandchildren: First one on the way! • Hobbies: Music, scuba diving, restoring classic cars.

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Oral and Maxillofacial Pathology Case of the Month John E. Kacher, DDS, director, JKJ Pathology—Oral Medicine-Oral Pathology, The Woodlands, Texas

Kacher

Clinical History A 36-year-old female patie t presents complaining of tenderness of the right buccal mucosa, subsequent to the restoratio of a dental implant at the #30 site about 6 months prior. The patie t reports that the area aches and annoys her. She also notes a small submucosal nodule in the right so palate of 2-3 months duration

Figure 1. Multiple partially-circinate reddish areas of the right buccal mucosa with an irregular border and fine white halo.

Clinically the right buccal mucosa has several reddish, partiall circinate lesions with a fin white halo (Figure 1). Also noted is a fissu ed tongue and a 3 mm submucosal nodule in the posterior right so palate (Figure 2). The patie t’s medical history is noncontributory; she takes no medication and reports no known allergies. She also denies any use of tobacco or alcohol and only takes multivi amin supplements. The patie t agreed to biopsy of the right buccal mucosa and also the right posterior so palate in order to establish a defini e diagnosis.

Histology

Figure 2. Photograph of patient’s fissured tongue.

The histology of the right buccal mucosa reveals stratifi squamous epithelium exhibitin a psoriasiform pa ern covering scant fib ous connecti e tissue Neutrophilic abscesses (Munro abscesses) are noted within the surface of the epithelium (Figure 3). The tissu specimen from the right posterior hard palate reveals lakes of extravasated mucinous material consistent with a mucocele. What is your diagnosis of the right buccal mucosa? See page 312 for discussion and answer.

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Figure 3. Histology revealing psoriasiform epithelium with neutrophilic abscesses.


TX-FEB-2014.pdf

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LAW OFFICES OF HANNA & ANDERTON EXPERIENCED LAWYERS REPRESENTING TEXAS DENTISTS MARK J. HANNA, JD Former General Counsel, Texas Dental Association

* Representation Before the Texas State Board of Dental

Examiners

* Medicaid Audits and Administrative Hearings * Employment Issues - Texas Workforce Commission

Hearings

FRANK B. WALKER, JD Former General Counsel, Texas State Board of Dental Examiners

* Standard of Care Reviews and Expert Opinions * Employment/Associateship Contract Reviews * Practice Acquisition and Sales * Business Organizations, PAs, PCs, and LLCs

ROBERT M. ANDERTON, DDS, JD, LLM Past President, Texas Dental Association and American Dental Association

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Reviews

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A PERKS PROGRAM FOR TDA MEMBERS

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prevalence of musculoskeletal

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CASE REPORT

Unusual Radiographic Finding During Routine Periodontal Maintenance: A Case Report Ahmed El-Halaby, DDS, MSD Michel V. Furtado Araújo, DDS, MSc, MDS

Case Presentation A 60-year-old female patie t presented for her periodontal maintenance appointment, during which a full mouth series of periapical and bitewing radiographs were obtained. Approximately 16 months prior to the appointment, the patie t’s lower left first molar (#19) was extracted due to recurrent decay (Figure 1). A ridge preservation procedure was performed using freeze-dried bone allograft (Maxxeus – Ke ering, Ohio) and a nonresorbable membrane (Osteogenics Biomedical – Lubbock, Texas), that was removed 1 month post operati ely (Figure 2). The procedure and subsequent healing were free of any complications Radiographic image acquisition using a digital sensor showed a radiopaque arti act in the shape of lines running on a sinuous trajectory in the lower left first molar region (Figure 3). This artifact extended over the edentulous alveolar ridge and continued to traverse the interocclusal space between the upper left first molar (#14) and the alveolar ridge of the lower left first molar (#19). This unusual finding was present in several radiographs taken of the same general area. On clinical examination, there was no edema, erythema, drainage, or discharge. In addition, no clinically visible lesions or any deviation from normal appearance was evident on the buccal mucosa adjacent to the first molar area. Radiographically, small radiopaque “dots” were seen in the edentulous ridge. These were also noted in the preoperati e radiograph and were diagnosed as metal debris remaining

El-Halaby

Araújo

Dr El-Halaby, private practice limited to periodontics, Longview, Texas. Dr Araujo, private practice limited to periodontics, Longview, Texas. Corresponding author: Ahmed El-Halaby, DDS, Pinnacle Implants and Periodontics, 444 Forest Square, Ste A, Longview, TX 75605; Phone: 903-758-3329;E-mail: halabyperio@gmail.com.

ABSTRACT This case report describes the presence of a radiopaque arti act appearing in multiple intraoral periapical and bitewing radiographs during routine periodontal maintenance, in an edentulous area with a history of a ridge preservation procedure. Clinical examination of the area showed a normal soft tissue appearance. Upon further investi ation of the patie t’s recent past medical history, it was found that the artifact was due to the presence of a dermal filler (Radiesse® — Merz Aesthetics, San Mateo, CA), which remained a er a facial cosmetic procedure. This unusual finding is an indication that clinicians should consider facial cosmetic dermal fillers as part of the differential diagnosis when unusual radiopaque objects are found during routine dental radiographs.

KEY WORDS: Dental radiograph, Radiographic artifacts, Periodontal maintenance, Radiesse, dermal fillers Tex Dent J 2014;131(4): 297-300.

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Figure 1. Preoperative radiographs. Extraction of #19 and ridge preservation using a freeze-dried bone allograft combined with a nonresorbable membrane were performed one month after these radiographs were taken.

as a result of previous restorati e treatment (#19 – Figures 1,2). A er examining the radiographs, the patie t was asked specifically if she had any facial cosmetic procedures performed since her last visit. The patie t had undergone facial cosmetic surgery consisting of a single session of injections of a dermal filler (Radiesse®) in the cheek area approximately 3 months prior to the appointment. Six months a er identi ying the arti act and during the subsequent periodontal maintenance visit, further radiographs were obtained (Figure 4). The previously identified adiographic arti act was almost completely absent, indicating that the remaining calcium hydroxylapati e (HA) particles from the Radiesse® injection were resorbing.

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Figure 2. Immediate postoperative periapical radiograph.


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Discussion To capture a radiographic image of the lower molars, the structures that the X-ray beams penetrate are: (i) the cheek, (ii) the buccal mucosa, cortex and periodontal ligament space, (iii) the tooth and adjacent alveolar process, and (iv) the lingual periodontal ligament space, mandibular cortex, and lingual mucosa. In the present case, during the course of the x-ray beam, a radiopaque object prevented the unrestricted passage of the x-rays to the digital sensor.

Figure 3. Radiographs taken at periodontal maintenance visit, 16 months after the extraction and ridge preservation. Radiopaque artifact in the shape of lines running on a sinuous trajectory in the lower left first molar region is evident.

Figure 4. Radiograph at second periodontal maintenance visit. Radio-opaque artifact barely visible.

An initial explanation considered was that the x-ray sensor cable was interposed between the x-ray cone and the digital sensor, which could cause the radioopaque artifact. This occurs infrequently and has a distinct appearance characterized by the presence of opaque and uniformly interlacing lines. However, the artifact appeared in more than one radiograph, including a bitewing and a periapical view. This would imply that the sensor cable was misplaced in the x-ray path multiple times, creating an arti act in the same site of the mouth with the same shape, which is extremely unlikely.

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The other equipment-related possibility considered was a defecti e digital sensor. However, a full mouth series of x-rays was taken and the arti act was only visible in one area and not in all the images captured by the same sensor. Therefore, it was found the sensor was working properly. The other possible explanation is that the artifact is of an intraoral origin. However, thorough clinical examination showed no deviation from normal tissue appearance. The investi ation then led to a possible facial origin, starting with the patie t’s cheek since it is the first structure to come in contact with the x-rays a er they depart the source. The sinuous pa ern and shape of the artifact resembled that of a large blood vessel. Therefore, the first suspicion was a calcifi ation of the wall of the facial artery. This artery traverses the area adjacent to the masseter muscle and is anatomically consistent with the radiographic location of the artifact. However, the relati ely large size of the artifact was not consistent with that of the facial artery. In addition, it was unknown to the author at the time of the appointment the incidence or possibility of the facial artery, or any other immediately adjacent structure, becoming calcified due to a pathological process. Another possibility was that the arti act was a result of a cosmetic procedure. Upon questionin , the patie t stated she had undergone “cosmetic injection fillings” on both the right and left cheeks. The patie t’s

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plastic surgeon was contacted for details regarding her procedure and it was found that the material used was Radiesse® (Merz Aesthetics, San Mateo, CA). This temporary injectable dermal filler is commonly used to augment facial and other tissues for cosmetic purposes. Radiesse® is a semi-solid suspension of calcium hydroxylapati e (HA) microspheres (25-45µm) in a gel carrier of carboxymethylcellulose. Over time, the HA is purportedly capable of creating a sca old allowing the patie t’s own newly formed collagen to accumulate. Radiesse®’s composition could explain the pa ern seen in the x-ray artifact. Once injected, the gel carrier penetrates the subdermal layer creating a sinuous path, which is evident in radiographs due to the radiopacity of HA. Interestingl , Radiesse does not consistently appear in radiographs, contrary to computed tomography (CT) studies that show Radiesse in a more consistent manner. One study found that immediately a er injections, Radiesse was evident in only 53% of the time in conventional radiographs (3). In this case report, Radiesse radiographically appeared on the left side only, even though the patie t had bilateral material injections. Only one other report exists in the dental literature documenting the radiographic appearance of Radiesse in the dental setting

Conclusion Clinicians should perform a thorough evaluation during periodontal maintenance visits. This way,

unusual findings can be diagnosed and properly addressed at an early stage. In this case report, an unusual radiopaque artifact created by the dermal filler Radiesse® was evident in dental x-rays during a maintenance visit. Clinicians should consider facial dermal fille s as a possible explanation for unusual radiopaque artifacts seen on intra-oral radiographs. References 1. Berlin AL, Hussain M, Goldberg DJ. Calcium hydroxylapati e filler for facial rejuvenation: a histologic and immunohistochemical analysis. Dermatol Surg. 2008 Jun; 34 Suppl 1:S64-7. 2. Moers-Carpi MM, Tufet JO. Calcium hydroxylapati e versus nonanimal stabilized hyaluronic acid for the correction of nasolabial folds: a 12-month, multice ter, prospecti e, randomized, controlled, split-face trial. Dermatol Surg. 2008 Feb; 34(2):210-5. Epub 2007 Dec 17. 3. Carruthers A, Liebeskind M, Carruthers J, Forster BB. Radiographic and computed tomographic studies of calcium hydroxylapati e for treatment of HIV-associated facial lipoatrophy and correction of nasolabial folds. Dermatol Surg. 2008 Jun; 34 Suppl 1:S78-84. 4. Valiyaparambil J, Rengasamy K, Mallya SM An unusual soft tissue radiopacity--radiographic appearance of a dermal filler. Br Dent J. 2009 Sep 12; 207(5):2112.


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CASE REPORT

Digital Dentistry and Implant Dentistry — A Case Study Richard Zimmermann, DDS Stefanie Seitz, DDS Donald Nyugen

Discussion The advancement of dental implants has changed the way denti ts approach oral rehabilitation — from replacement of a single tooth to enti e arches (1,2,3). As dental implants have evolved, along with other aspects of denti try, the way in which we approach implant therapy is changing. The following case illustrates various advances made in denti try and the e ect they have on patie t treatment. A 52 year-old male presented to the UTHSCSA Dental School predoctorate clinic for the replacement of tooth #30. After initial diagnosis and treatment planning, the patie t was referred for a cone beam computed tomography image (CBCT) for site #30. While traditional imaging (periapicals and a panograph) would only provide a 2-D view of the site, the CBCT provides a more accurate 3-D image of the site and surrounding structures (4,5). Once the CBCT is obtained, the image (DICOM) files can be imported into either viewing or planning software. Planning software renders a 3-D model of the scanned site which can be viewed from any angle and also allows the user to virtually place implants. By doing this, the surgeon is be er able to evaluate the proposed implant site and the surrounding structures to determine the Dr Zimmermann is an assistant professor, Comprehensive Denti try, UTHSCSA Dental School, San Antonio, Texas. Dr Seitz is an assistant professor, Comprehensive Denti try, UTHSCSA Dental School, San Antonio, Texas. Donald Nyugen is a fourth year dental student, UTHSCSA Dental School, San Antonio, Texas.

Corresponding author: Richard Zimmermann, DDS, 7703 Floyd Curl Dr Mail Code 7914, San Antonio, Texas 78229-3900; email: zimmermannR@uthscsa.edu; phone: 210-567-3900. The authors declare potential conflicts of financial interest, relationshi s, and/or affil tions relevant to the subject ma er or materials discussed in the manuscript and provide full disclosure. The authors would like to thank Straumann, Ivoclar, and Sirona for their support of the pre-doctoral program at the University of Texas Health Science Center at San Antonio Dental School.

ABSTRACT In the area of fixed prosthodontics, implants have evolved to become the gold standard in terms of longevity and esthetic outcome (1). As in all of denti try, careful diagnosis and treatment planning is a must to achieve an optimum result (2,3). When evaluating the recipient site, one must determine if any type of defect (hard or soft tissue) exists which would require augmentation. The existing occlusion must also be evaluated to ensure the denti t is aware of possible prosthetic complications. In straigh orward cases, such as those without the need for augmentation, the conventional timeline requires a waiting period of 3 months following surgical placement to begin the restorati e procedures. Factoring in the restorati e time frame, the patie t may wait up to approximately 4 months for the final implant prosthesis. Various advancements in denti try are changing the way denti ts approach implant denti try — from diagnosis and treatment planning to final restorations. This article illustrates these advances through a case study. KEY WORDS: digital denti try, dental implants Tex Dent J 2014;131(4): 303-308.

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Figure 1. Placement planned in Anatomage Invivo5 software.

appropriate implant and whether or not augmentation will be necessary. For this case, the patie t’s DICOM files were imported into Invivo5 (Anatomage) implant planning soft are to evaluate the proposed implant site and the location of the inferior alveolar (IA) canal (Figure 1). To more easily visualize the path of the nerve, this software allows the user to trace the canal and subsequently identifies the path via a red tube. If a virtual implant is placed within 2 mm of the IA path, a warning will appear on the screen indicating the proximity. After evaluating the site, it was determined the case was straigh orward as set by ITI guidelines and fit within the scope of the Implant Selecti e at UTHSCSA Dental School (6). This selective provides fourth year dental students the opportunity

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to diagnose and treatment plan, surgically place and restore dental implants (7). An implant with chemically modified, sandblasted and acid-etched surface (SLActi eÂŽ, Institut Straumann AG, Basel, Switzerland) was selected for placement. Several studies have demonstrated that implants with a sandblasted and acid-etched surface (SLAÂŽ, Institut Straumann AG, Basel, Switzerland) may be loaded between 6-8 weeks and that same surface, when chemically modified, can be subjected to an earlier loading of 4-6 weeks a er placement (8,9,10). These loading protocols exhibit success rates similar to traditional loading protocols, but the denti t must ensure the patie t is in good systemic health with no compromised healing (11, 12). In addition, it is

necessary that the proposed implant site has healed for over 4 months and that augmentation is not necessary (13,14). If primary stability of the implant is not obtained or the patie t exhibits any of the previously mentioned limitations, a traditional loading protocol is recommended. The shortened loading protocol is an advantage in the academic settin because students within the selective are exposed to both the surgical and restorati e aspects of a given case so they can understand how each of these aspects is influenced by the other. In private practice, the shortened loading time can increase patie t acceptance of implant therapy and decrease the overall patie t treatment timeline. The surgery was performed using a non-restricti e surgical guide


CASE

Figure 2. Impression post at time of surgery.

for placement orientation. A nonrestricti e guide allows for the evaluation of the osteotomy trajectory throughout the surgery. A restricti e guide can only be used with the initial surgical drill. This type of guide allows for more accurate placement mesio-distally and bucco-lingually, but does not allow for the evaluation of any angle modifications that might arise during the surgery. The surgery was uneventful and resulted in the successful placement of a 4.8x12mm Straumann Roxolid Bone Level RC with primary stability. To facilitate the restorati e process, an implant level impression (Aquasil, Dentsply) was obtained prior to repositioning of the flap (Figure 2). The healing abutment was placed with care to avoid rotating the implant and thus rendering the impression inaccurate. The flaps were then repositioned and held in place with two 4-0 chromic sutures. The patie t was given post-operati e instructions and appointed for a 1 week follow up appointment.

Once the master cast was fabricated from the impression, the implant placement was evaluated for restoration. The use of the surgical guide and careful a ention to drill angulation during surgical steps resulted in the screw access hole being located in the center of the proposed restoration, allowing for a screw-retained restoration. Historically the fabrication of screw-retained implant prostheses necessitated the use of a dental laboratory with a technician who was skilled at casting implant prostheses. However, current CAD/ CAM technology and materials are changing what can be fabricated within a dental office. Over the years, implant companies have increased their selection of stock abutments that offer a variety of shapes, angulations, heights, diameters and margin locations. For this case, the desired stock abutment (RC cementable abutment,

REPORT

Straumann) was selected and slightly modified to increase the anti rotational features. Both the master cast (with stock abutment) and the opposing maxillary cast were then scanned using Sirona’s CEREC AC. The final restoration was designed using Sirona’s CAD/CAM software (CEREC 4.0) with a screw access channel that lined up with the abutment screw channel. (Figure 3) The completed design was then milled by a CEREC MCXL (Sirona) for the final restoration. Lithium disilicate (IPS e.max, Ivoclar Vivadent) was chosen due to its high strength, excellent esthetics and proven clinical track record (15,16,17,18). This material is milled in a lithium metasilicate phase that has a distinct blue/purple color (Figure 4). The material has a lower strength in this state, making it easier to mill and adjust. After adjustments are made, the restoration is put through a crystallization firing cycle that converts the lithium metasilicate to tooth-colored lithium disilicate. Characterization of the material can be done before the crystallization firing or in a subsequent firing sequence — most practition s prefer the la er because the final shade is apparent. Finally, the crown was bonded to the abutment following manufacturer’s guidelines with adhesive cement (multilink implant, Ivoclar Vivadent). Special care was taken to ensure that cement did not flow into the screw access channel. The final screwretained restoration was tried in and delivered following implant protected occlusion guidelines — slight contact in maximum intercuspation upon clenching (19, 20, 21). Teflon tape was placed over the screw head and the Texas Dental Journal l www.tda.org l April 2014

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Figure 3. Restoration design in CEREC 4.0 software.

channel filled with composite (Figure 5). The total time from surgical implant placement to delivery of the final restoration was approximately 7 weeks. This case illustrates the use of current technology and supporting literature to decrease the total treatment time for implant restorations. While the initial results are quite promising, it must be kept in mind that to achieve these results several criteria must be strictly followed: • •

• •

Patie t is in good health (both orally and physically), without any healing issues; The proposed implant site must be free of infection and have healed a minimum of 4 months; The implant achieves primary stability and does not require osseous augmentation; and Occlusion is limited to slight centric contact upon clenching.

This accelerated timeline is not recommended for the anterior region because it has been shown that soft tissue can continue to remodel for 3 months a er surgery (22,23, 24). Ignoring this fact could result in the exposure of the abutmentcrown interface and an unesthetic restoration. For these cases, it is preferable to place the patie t in a provisional restoration to allow for complete remodeling of the soft tissue.

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Figure 4. Milled restoration in lithium metasilicate.

This simple straigh orward case demonstrated the way in which technological and material advances are altering the way implant patie ts are treated. While an implant case was used for illustration, one must remember that the techniques and technology are not limited to implants but are being used for other aspects of denti try also. One such example is the use of CBCTs in endodontics. But as in all of denti try, one must make sure to be familiar with the indications and contraindications of the technology being used.


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References 1.

Egbert N, Ahuja SA, Brandt RL, Jain V, Wicks RA. Single tooth replacement utilizing implants in the esthetic zone: a case report. Gen Dent. 2013 Jul;61(4):30-4. 2. Al-Sabbagh M. Implants in the esthetic zone. Dent Clin North Am. 2006 Jul;50(3):391-407, vi. 3. Jansen CE, Weisgold A. Presurgical treatment planning for the anterior singletooth implant restoration. Compend Contin Educ Dent. 1995 Aug;16(8):746, 748-52. 4. Pires CA, Bissada NF, Becker JJ, Kanawati A, Landers MA. Mandibular incisive canal: cone beam computed tomography. Clin Implant Dent Relat Res. 2012 Mar;14(1):6773. 5. Angelopoulos C, Thomas SL, Hechler S, Parissis N, Hlavacek M. Comparison between digital panoramic radiography and cone-beam computed tomography for the identi ation of the mandibular canal as part of presurgical dental implant assessment. J Oral Maxillofac Surg. 2008 Oct;66(10):2130-5 6. Belser UC, Mericske-Stern R, Bernard JP, Taylor TD. Prosthetic management of the partially dentate pati nt with fixed implant restorations. Clin Oral Implants Res. 2000;11 Suppl 1:126-45. 7. Zimmermann R, Hendricson WD. Introduction of an implant surgical selecti e into a predoctoral dental curriculum. J Dent Educ. 2011 Sep;75(9):1256-62 8. Kokovic V, Jung R, Feloutzis A, Todorovic VS, Jurisic M, Hämmerle CH. Immediate vs. early loading of SLA implants in the posterior mandible: 5-year results of randomized controlled clinical trial. Clin Oral Implants Res. 2012 Dec 21. doi: 10.1111/clr.12072. 9. Lethaus B, Kälber J, Petrin G, Brandstä er A, Weingart D. Early loading of sandblasted and acid-etched titanium implants in the edentulous mandible: a prospecti e 5-year study. Int J Oral Maxillofac Implants. 2011 Jul-Aug;26(4):887-92. 10. Karabuda ZC, Abdel-Haq J, Arisan V. Stability, marginal bone loss and survival of standard and modified sand-blasted, acidetched implants in bilateral edentulous spaces: a prospecti e 15-month evaluation. Clin Oral Implants Res. 2011 Aug;22(8):8409. 11. Bornstein MM, Wittneben JG, Brägger U, Buser D. Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted

Figure 5. Final restoration after crystallization characterization firing cycle.

12.

13.

14.

15.

16. 17.

and acid-etched surface: 3-year results of a prospecti e study in the posterior mandible. J Periodontol. 2010 Jun;81(6):809-18. Schätzle M, Männchen R, Balbach U, Hämmerle CH, Toutenburg H, Jung RE. Stability change of chemically modified sandblasted/acid-etched titanium palatal implants. A randomized-controlled clinical trial. Clin Oral Implants Res. 2009 May;20(5):489-95 Salvi GE, Gallini G, Lang NP. Early loading (2 or 6 weeks) of sandblasted and acidetched (SLA) ITI implants in the posterior mandible. A 1-year randomized controlled clinical trial. Clin Oral Implants Res. 2004 Apr;15(2):142-9 Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F. Immediate and early loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla: 1-year results from a prospecti e multicenter study. Clin Oral Implants Res. 2008 Nov;19(11):1119-28. Kim JH, Lee SJ, Park JS, Ryu JJ. Fracture load of monolithic CAD/CAM lithium disilicate ceramic crowns and veneered zirconia crowns as a posterior implant restoration. Implant Dent. 2013 Feb;22(1):66-70. Reich S, Schierz O. Chair-side generated posterior lithium disilicate crowns a er 4 years. Clin Oral Investig. 2012 Nov Prevedello GC, Vieira M, Furuse AY, Correr GM, Gonzaga CC. Esthetic rehabilitation of anterior discolored teeth with lithium disilicate all-ceramic restorations. Gen

Dent. 2012 Jul-Aug;60(4):e274-8 18. Fasbinder DJ. Chairside CAD/CAM: an overview of restorati e material options. Compend Contin Educ Dent. 2012 Jan;33(1):50, 52-8 19. Misch CE, Bidez MW. Implant-protected occlusion: a biomechanical rationale. Compendium. 1994;15:1330, 1332, 1334 20. Rilo B, da Silva JL, Mora MJ, Santana U. Guidelines for occlusion strategy in implant-borne prostheses: a review. Int Dent J. 2008;58:139–145. 21. Yuan JC, Sukotjo C. Occlusion for implantsupported fixed dental prostheses in partially edentulous pati nts: a literature review and current concepts. J Periodontal Implant Sci. 2013 Apr;43(2):51-7. 22. Luo Z, Zeng R, Luo Z, Chen Z.Single implants in the esthetic zone: analysis of recent peri-implant soft tissue alterations and patie t sati faction. A photographic study. Int J Oral Maxillofac Implants. 2011 May-Jun;26(3):578-86. 23. Becker W, Doerr J, Becker BE. A novel method for creating an optimal emergence profile adjacent to dental implants. J Esthet Restor Dent. 2012 Dec;24(6):395-400 24. Rodriguez AM, Rosenstiel SF. Esthetic considerations related to bone and soft tissue maintenance and development around dental implants: report of the Committee on Research in Fixed Prosthodontics of the American Academy of Fixed Prosthodontics. J Prosthet Dent. 2012 Oct;108(4):259-6.

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INFORMED REFUSAL: A Review The Medical Protective Company Most health care providers know that a patie t’s signature on an informed consent document may not automati ally make the consent valid. The same is true of informed refusal. Both of these concepts rely on ethical and legal guidelines that acknowledge the right of competent adults to determine the course of their health care.

This decision-making process requires consultation between doctor and patie t to determine the best treatment option and to ensure that the patie t has been a partner in selecting the appropriate treatment. A signature merely documents the occurrence of this process; without it, the signature means nothing. Patie t education and documentation are the doctor’s best allies for gaining

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a patie t’s cooperation in selection of a treatment plan. However, a patie t can refuse care even if the consequences might be dire. When a patie t refuses care, the doctor should scrupulously document in the patie t’s record all e orts to explain the risks associated with lack of treatment. The doctor may ask the patie t to sign and date the entry. The documentation should include the patie t’s diagnosis, the recommended


treatment, and the risks that may occur if the condition isn’t treated. For example, the risks may include the following: (a) treatment options may diminish as the condition deteriorates; (b) the doctor may have less opportunity to e ect a successful outcome; (c) complications might increase or worsen; and/or (d) remaining treatment options might be more expensive. Patie ts also have the right to change their minds and withdraw consent for treatment they have previously authorized, even a er the treatment has started. When a patie t wants to abandon a treatment plan, the doctor should carefully document the decision, using the framework of informed refusal. Documentation should include the following considerations: •

Was the patie t given adequate information about the diagnosis and treatment options that meet the current standard of care? Were the risks and benefits of treatment options discussed with the patie t? Had doctor and patie t discussed and agreed upon their mutual expectations for a sati factory outcome? Was the patie t encouraged to ask questions and voice his or her concerns? Were these questions and concerns addressed to the patie t’s sati faction? Did the doctor ask for the patie t’s reason for the decision? Knowing the patie t’s reason for refusal, the doctor can sometimes propose an acceptable alternati e that the patie t will accept. Did the doctor document his or her explanation of the risks associated with refusal of treatment? If the doctor opts to use an informed refusal form, the patie t should be given a copy of the signed document, and the

original should be retained in the patie t’s file. The form should include: o o o o o

The diagnosis; Treatment options and the treatment plan the patie t elected, as well as risks and benefits associated with each; Acknowledgement that the patie t refused or terminated treatment; Specific risks that might occur if the patie t doesn’t receive care, and acceptance of the risk on the part of the patie t; and The patie t’s signature (if he or she agrees to sign).

Although it is not always necessary that the patie t sign an informed refusal form, the request forces the patie t to acknowledge the seriousness of the untreated condition. Many patie ts sign; some refuse. If the patie t refuses to sign, the doctor should note that the patie t was asked to sign the statement and would not do so. Some doctors like to have a witness present when a patie t refuses needed care. When an employee has been asked to witness the informed refusal process, he or she should sign the record and date the signature — whether the patie t agrees to sign or not. By refusing urgently needed care, a patie t might increase his or her risk of injury and possibly increase the doctor’s liability. Under these circumstances, some doctors feel they have no other choice but to formally acknowledge the patie t’s refusal of care. Other doctors continue to see and treat such patie ts with the hope that the patie t may change his or her mind, or that if the patie t’s condition deteriorates, emergent care can still be initiated.

If the doctor decides to dismiss a patie t from the practice because of the refusal, a discussion should take place, preferably before the formal discharge process occurs. The patie t should know that the doctor feels strongly enough about the needed treatment that he or she would dismiss the patie t from the practice, rather than stand by as a witness to the deterioration of his condition. The doctor should formalize the dismissal with a discharge le er, giving the patie t adequate time (generally 30 days) to find another practition . The le er should be sent to the patie t via certified mail with return receipt requested, and an additional copy should be sent through standard mail. Copies of the le er should be maintained in the patie t’s file. When a patie t refuses care, the doctor needs to ensure that the patie t understands the risks that may result from the decision, and that his or her warnings are thoroughly documented. When in doubt about how to handle a patie t’s refusal of treatment or withdrawal from a treatment plan, the doctor should contact a risk management expert. This article was provided by the clinical risk management team at Medical Protective, a TDA Perks Program partner and the nation s oldest professional liability insurance company dedicated to the healthcare professions. For additional information, please contact Laura Cascella at laura.cascella@medpro. com or visit the Medical Protective website at: medpro.com/. For information regarding other TDA Perks Programs, please visit tdaperks. com or call 512-443-3675. © The Medical Protecti e Company. 2014. All rights reserved.

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Oral and Maxillofacial Pathology Diagnosis and Management

Ectopic Geographic Tongue (Erythema migrans) Oral and Maxillofacial Pathology Case of the Month (from page 292)

Discussion The clinical and microscopic findings support a diagnosis of ectopic geographic tongue. While geographic tongue located on the tongue is fairly common, this process can also a ect other sites such as the lips, buccal mucosa, and palate. In these sites the clinical appearance is similar to the lesions located on the tongue, excepting that lesions on the tongue additionally show fla ening or atrophy of the papillae within the central area.

Clinical Features Erythema migrans is reported to occur in 1-3% of the population (1). There is a female predilection, and many cases can go undetected by the patie t for some time until the tongue becomes sensiti e or the patie t notes the appearance of the lesions. Characteristi ally the process a ects the anterior two-thirds of the tongue. The lesions appear as multiple zones of erythema exhibiting atrophy of the filiform papillae. These areas of atrophy are surrounded by a slightly elevated, yellow or white halo. The size and location of the multiple lesions will shift over time, and this phenomenon has been likened to the changing shapes of contine ts on a spinning globe (thus the name “geographic tongue”).

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Typically the lesions are asymptomatic, although sensitivity to hot or spicy foods may develop over time. There is a defini e association between fissured tongue and geographic tongue (2). It is unusual to see other sites a ected by erythema migrans, although in these cases the tongue is also almost always a ected (3). Other sites involved are the buccal mucosa, labial mucosa, and/or soft palate. The histology of geographic tongue is diagnostic and is very helpful in cases of ectoptic geographic tongue as the lesions can be confused with candidiasis, mucositis, or mucous membrane diseases. Interestingl , the histology of erythema migrans closely resembles the skin condition psoriasis, although no defini e link between these 2 conditions has been made in the literature. Studies have shown that psoriasis and erythema migrans are associated with the anti en HLACw6 (4).

Treatment/Prognosis For patie ts that have symptomatic erythema migrans the treatment of choice is topical steroids. On areas such as the tongue, ointments do not tend to stick due to the highly mobile nature of this organ. Therefore, a treatment modality that address this issue is to prescribe dexamethasone

elixir and have the patie t soak a 2x2” gauze in the liquid; then hold the gauze on the a ected area with the mouth closed at least 5 minutes, 4 times a day. For this patie t we prescribed clobetasol ointment mixed with triamcinolone acetonide dental paste for her right buccal mucosa. She also later complained of sensitivity on her tongue for which we prescribed the dexamethasone elixir with the gauze regimen. At 3 weeks this treatment alleviated the patie t’s symptoms and also resolved the clinical appearance of the ectopic geographic tongue (Figure 4).

Differential Diagnosis * * * *

Lichen planus Candidiasis Reaction to drugs or dental materials Ectopic geographic tongue

References 1. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology, 3rd edition. Philadelphia: WB Saunders Company 2009; 51-54. 2. Jainki ong A et al. Geographic tongue: clinical characteristics of 188 cases, Journal of Contemporary Dental Practice 6:1, 2005.


3. Weathers DR et al. Psoriasiform lesions of the oral mucosa (with emphasis on “ectopic geographic tongue), OOO 37:6, 872-888, 1974. 4. Gonzaga HF et al. Both psoriasis and benign migratory glossitis are associated with HLA-Cw6, British Journal of Dermatology 135:3, 368-370, 1996. Special thanks to Dr King Hardy for sharing this case.

Figure 4. Three weeks post-op showing resolution of lesions on right buccal mucosa.

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CALENDAR OF EVENTS MAY2014 1-4

2

314

The Texas Dental Association will host its annual TEXAS Meeting at the Henry B. Gonzalez Convention Center in San Antonio, Texas. For more information, please contact Sandy Blum, Annual Session Director, TDA, 1946 S IH 35 Ste 400, Austin, TX 78704; Phone: 512-443-3675; FAX: 512-443-3031; Email: sblum@tda.org; Website: texasmeeting. om. The TDA Smiles Foundation holds its TDA Smiles Foundation Golf Classic at the Quarry Golf Club in San Antonio, with a shotgun start at 7:00 am. To register as a player, Texas Dental Journal l www.tda.org l April 2014

foursome, or become a sponsor, please contact Director Judith Gonzalez, TDASF, 1946 S IH 35 Ste 300, Austin, TX 78704; Phone: 512448-2441; Email: judith@tda.org; Website: tdasmiles.org.

19-21

The American Dental Association will host its annual Washington Leadership Conference in Washington, DC. For more information, please contact Brian Sodergren, ADA, 1111 14th St, NW Ste 1100, Washington, DC 20005; Phone: 202-789-5168; FAX: 202-7892258; Email: sodergrenb@ada.org; Website: ada.org.


JUNE2014

SEPTEMBER2014

6-7

8-13

14

The Texas Academy of General Denti try will host its annual New Denti t Conference at the Omni Southpark Hotel in Austin, Texas. For more information please contact Lindsey Robbins, Education Director at TAGD, 409 W Main St, Round Rock, TX, 78664; Phone: 512-2440577; FAX: 512-244-0476; Email: lindsey@tagd.org; Website: tagd.org. The TDA Smiles Foundation will hold a 14-chair Texas Mission of Mercy in Mineral Wells. For more information, please contact Foundation Manager Judith Gonzalez at TDASF, 1946 S IH35 Ste 300, Austin, TX 78704; Phone: 512448-2441; Email: judith@tda.org; Website: tdasmiles.org.

JULY2014 19 & 20

The American Academy of Periodontology, in collaboration with the American Association of Endodonti ts & American College of Prosthodonti ts, present the 2014 AAE/AAP/ACP Joint Symposium: “Teeth For a Lifetim : Interdisciplinary Evidence For Clinical Success” at the Swissôtel in Chicago, IL. For more information please contact Ms Susan Schaus, AAP, 737 N Michigan Ave Ste 800, Chicago, IL 60611; Phone: 312-787-5518; Fax: 312-787-3670; Email: susan@perio. org; Website: perio.org.

19-22

The American Association of Oral and Maxillofacial Surgeons presents its 96th annual meeting at the Hawaii Convention Center in Honolulu, HI. For more information, please contact Dr Robert C. Rinaldi, AAOMS, 9700 W Bryn Mawr, Rosemont, IL 60018; Phone: 847678-6200; Fax: 847-678-6286; Email: inquiries@aaoms.org; Website: aaoms.org. The American Academy of Periodontology presents its annual meeting in San Francisco, CA. For more information, please contact Mr John Forbes, AAP, 737 N Michigan Ave Ste 800, Chicago, IL. Phone: 312-787-5518: Fax: 312-7873670; E-mail: aap-info@perio.org; Website: perio.org.

OCTOBER2014 9-14

The American Dental Association presents its annual meeting at the Henry B. Gonzalez Convention Center in San Antonio, TX. For more information, please visit ada.org.

THE TEXAS DENTAL JOURNAL’S CALENDAR will include only meetings, symposia, etc., of statewide, national, and international interest to Texas denti ts. Because of space limitations, individual continuing education courses will not be listed. Readers are directed to the monthly advertiseme ts of courses that appear elsewhere in the Journal.

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TEXAS DENTAL ASSOCIATION 143RD ANNUAL SESSION

2013 TEXAS Meeting Photo Contest Photographer: William T. Parker, DDS, Dallas Title: “Storm Coming In” Category: Natural Wonders Information on the 2014 TEXAS Meeting Photo Contest is available on texasmeeting. om.

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MEMORIAL and HONORARIUM Donors

In MEMORIAM

to the Texas Dental Association Smiles Foundatio

Those in the dental community who have recently passed

IN MEMORY OF:

Cooper, Bruce Walker

Robert Parsons Dr Beverly Zinser

Dr Bradley Whitt Dr Don Lutes

Kristine Stubbins Dr Beverly Zinser

Dr Bill Butler Susan Taylor

Clara Urna Dr Beverly Zinser Dr Kent Macaulay Dr Paul E Stubbs

Eddie Anderton Dr Beverly Zinser Dr Paul E Stubbs Your memorial contribution supports: • •

educating the public and profession about oral health; and improving access to dental care for the people of Texas.

Please make your check payable to:

TDA Smiles Foundation, 1946 S IH 35, Austin, TX 78704

Serving Texas Dentists for Over 15 Years

Garland, Texas October 2, 1926 – February 21, 2014 Good Fellow: 1983 Life Member: 1991 50 Year: 2008

Dodson, Richard L. Dallas, Texas September 26, 1925 – March 14, 2014 Good Fellow: 1988 Life Member: 1990 50 Year: 1999

Fausett, Lee Roy DeSoto, Texas March 10, 1930 – June 23, 2013 Good Fellow: 1984 Life Member: 1995 50 Year: 2008

Green, Wade Kenneth Let us handle your dental credentialing headache at an affordable price! Services include: Complimentary Zip Code Fee Analysis Upfront Fee Negotiations Initial Applications Yearly Fee Negotiations Status Reports of Credentialing Notifications of Document Renewals/ReCredentialing Tracking of Eligibility for Fee Increases Consultation/Training

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ADVERTISING BRIEFS PRACTICE OPPORTUNITIES ABBEVILLE DENTISTRY: We are seeking an honest, hardworking, patie t focused denti t who want to contribute to a culture of caring, nurturing and skilled professionals. If you have the desire to be a part of a team where you can focus on patie ts and not worry about the headaches that come with the business side of denti try, please call us. If you are seeking an environment that provides stability, growth and continuing education, weíd like to share with you how you can fit into that plan. Twenty years ago, I started my practice simply dedicated to serving my patie ts and community. Now, Iím privileged to guide over 10 practices and 80 wonderful sta . Iíve turned the administrati e, operations and marketing e orts over to people who enjoy doing those sorts of things so our doctors and staff can focus on their patie ts. Iíve also been able to provide young doctors with an environment where they can grow and practice what they love doing without the worry of costly overhead or administrati e headaches. At the same time, offering the potential for significant income and a great life balance. Youíll enjoy a great environment with no egos and no politi al barriers. Weíre growing and need a few quality individuals to join us in creating something truly special. Weíre forming a new, interacti e, fun environment that kids and their parents will find refreshing and exciting. If youíd like to talk about this opportunity, please give me a call. Iíd be happy to share the vision, the success and the expectations we have while answering your questions

ADVERTISING BRIEF INFORMATION SUBMISSION AND CANCELLATION DEADLINE: 20th, 2 months prior to publication (eg, November 20th for January issue) MONTHLY RATES: First 30 words = $40; each additional word = 10¢ Ads must be submitted via e-mail, fax, or web through tda.org and are not accepted by phone. Journal editors reserve the right to edit copy of classified advertis ments. Any denti t advertising in the Texas Dental Journal must be a member of the American Dental Association. Advertisem nts must be not quote revenues or gross or net incomes; only generic language referencing income will be accepted.

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candidly and openly. I hope you’ll consider this position and give me a call. Call Bri Bos ck, DDS, 806-438-5745 or email bbost35821@aol.com. ADS WATSON, BROWN & ASSOCIATES: Excellent practice acquisition and merger opportunities available. DALLAS AREA: 5 general denti try practices available (East Dallas, Richardson, Southeast of Dallas, and North of McKinney). FORT WORTH AREA: 2 general denti try practices (West Fort Worth and Arlington). NORTH TEXAS: 2 pediatric practices. HOUSTON AREA: 1 orthodontic practice. EAST TEXAS AREA: 1 general denti try practice. WEST TEXAS AREA: 1 general denti try practice. AUSTIN AREA: 1 general denti try practice available northwest of Austin. BRYAN/COLLEGE STATION AREA: 1 general denti try practice available. SAN ANTONIO AREA: 1 general denti try practice available. OKLAHOMA AREA: 1 general denti try practice available. For more information and current listings, please visit our website at www.adstexas.com or call ADS Watson, Brown & Associates at 469-222-3200. AMARILLO: General denti t for a locally owned practice looking to provide care for our patie ts as well as build their own patie t base. Ownership opportunity available. Please contact Bri Bos ck, DDS, bbost35821@aol.com or call 806-438-5745. AMARILLO: Pediatric denti t for a locally owned practice looking to provide care for our patie ts as well as build their own patie t base. Ownership opportunity available. Please contact Bri Bos ck, DDS, bbost35821@aol.com or call 806-438-5745. ARLINGTON / FORT WORTH: Associate position available. Full time denti t and specialist needed to join our successful dental group in Arlington & Fort Worth. Interested candidates should email CV to txdentaljobs@ gmail.com. ASSOCIATE FOR TYLER GENERAL DENTISTRY PRACTICE: Well-established general denti t in Tyler with over 34 years experience seeks a caring and motivated associate for his busy practice. This practice provides exceptional


ASSOCIATE FOR TYLER GENERAL DENTISTRY PRACTICE: Well-established general denti t in Tyler with over 34 years experience seeks a caring and motivated associate for his busy practice. This practice provides exceptional dental care for the enti e family. Our office is located in beautiful East Texas and provides all phases of quality denti try in a friendly and compassionate atmosphere. The practice offers a tremendous opportunity to grow. The practice offers excellent production and earning potential with a possible future equity position available. Our knowledgeable staff will support and enhance your growth and earning potential while helping create a smooth transition. Interested candidates should call 903-509-0505 and/or send an e-mail to steve.lebo@sbcglobal.net. ASSOCIATE NEEDED FOR DENTAL OFFICE in small, quaint town. Potential for practice purchase. 361-6458148. AUSTIN: Progressive, patie t centric office is seeking an experienced denti t; must be friendly, caring and professional. Opportunity is available (if desire) for practice ownership. Serious inquiries email: fahoosha@ gmail.com, mike@miloinc.com. AUSTIN PEDIATRIC PRACTICE SEEKING FULL TIME ASSOCIATE: Great benefits! Progressive, fast-paced practice. Capable caring sta . We are looking for a bright career-oriented pediatric denti t to join an organization commi ed to providing high quality dental care to children and adolescents. Our dental team strives to offer exceptional care with integrity. For consideration send your confide tial resume to dentalresume27@yahoo.com. AUSTIN PRIVATE PRACTICE SEEKS ASSOCIATES (GPs, Prosthodonti ts) due to growth and increased capacity. Excellent compensation / benefits. Email resume to operations@omnide talgroup.com or call 512-773-9239.

AUSTIN, SAN ANTONIO AND DALLAS AREA PRACTICE OPPORTUNITIES MCLERRAN & ASSOCIATES: CORPUS CHRISTI AREA (ID #T231): This is an opportunity to purchase an established, general denti try practice located on the south coast of Texas in an area that is experiencing rapid growth as a result of oil drilling in the nearby Eagle Ford Shale. The practice has a large, feefor-service/PPO patie t base, strong new patie t flow, consistent annual revenue of mid-6 figures, and solid cash flow.The office occupies a free standing building with 2 fully equipped operatories (digital X-ray units and computers) and ample room to add 2-3 additional operatories. The real estate is owned by the seller and being offered for sale at fair market value. Given its close proximity to the Gulf of Mexico, this turnkey practice is an ideal opportunity for an avid fisherman/outdoorsman or beach lover. SOUTH OF SAN ANTONIO (ID #T235): This established general denti try practice is located on a main thoroughfare in a quaint, rural town located approximately 90 miles southeast of San Antonio. This practice is in a high growth, low competition area in the Eagle Ford Formation. The practice has realized consistent annual revenue of low-6 figures over the past 2 years while maintaining low overhead, strong profi ability of 50%, and solid new patie t flow. The office space of the practice encompasses 1,200 sq ft and has 3 fully equipped operatories with digital X-ray units and computers (one additional plumbed operatory for expansion). The building is also being offered for sale. NEW BRAUNFELS (ID #T226): This established, fee-for-service general family practice is located in the rapidly growing area of New Braunfels along the IH-35 corridor between Austin and San Antonio. The practice boasts a 100% fee-for-service patie t base and is located in a free-standing building with 3 fully equipped operatories. The practice is not in network with any PPOs and relies solely on word-of-mouth referrals for new patie ts, and refers out a substantial amount of specialty work, providing the new owner with solid upside potential. The annual revenue of the practice has

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ADVERTISING BRIEFS consistently been in the low-6 figures per year. Excellent opportunity to purchase an established practice for much less than the cost of a start up! SAN ANTONIO (ID #T218): This general family practice on the northwest side of San Antonio, just outside of loop 410, is located in a high traffic etail location and presents a unique opportunity to att act and retain patie ts. The practice is located in a turn-key, 7-operatory (6 equipped) office, boasts an active patie t base. The practice has collected mid-6 figures the last 12 months with strong cash flow. This is an excellent opportunity with tremendous upside potential. Priced to sell! SAN ANTONIO (ID #T209): This established pediatric practice is located in East Central San Antonio in a medical/ dental building. The practice has seen consistent annual revenue of low-6 figures over the last 3 years with strong net income. The office has 3 fully equipped operatories, strong upside potential, and would be an att acti e standalone practice or ideal satellite location. SAN ANTONIO (ID #T181): This general, family practice is located in West/Central San Antonio and boasts a large, PPO/ Medicaid patie t base. This turnkey office is paperless and computerized, has 4 fully equipped operatories with recently updated equipment, and provides room for expansion. The practice has seen consistent annual revenue of mid-6 figures over the past few years with strong net cash flow. This is an ideal solo practice or satellite office with tremendous upside potential. SAN ANTONIO (ID #T159): This oral surgery practice has a solid referral base, great location, att acti e build-out, excellent equipment, and stable revenue/cash flow. The practice owner is available for a transition. HILL COUNTRY WEST OF AUSTIN (ID #T236) This predominately fee-for-service general family practice is located in a desirable community in the heart of the Texas Hill Country. It boasts a great reputation and has been in its current location since 1980. The office has three fully equipped operatories, with the ability to add an additional operatory. There is a strong opportunity for growth, as the owner is not acti ely marketing the practice, does not participate in

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any PPO’s and is referring out a fair amount of specialty procedures. The practice has a strong foundation of active patie ts with a good amount of upside potential. This is an excellent opportunity for someone who enjoys the beautiful Hill County and wants to get away from the big city. NORTHWEST AUSTIN (ID #T234) This established practice is located in a busy retail center in a rapidly growing community located just a few minutes Northwest of Austin. The practice has a fee-for-service/PPO patie t base, consistent annual collections of mid-6 figures and strong upside potential. The office has a modern decor, 4 fully equipped operatories with computers and digital X-ray units, and room for expansion. The selling doctor is available for a transition. AUSTIN (ID #T233) Unique opportunity to purchase a high cash flowing prosthodontic and general practice, with a focus on implants, in rapidly growing Austin. The practice has excellent cash flow, high end equipment, year over year growth and is truly a turnkey opportunity for the right doctor. For more information, please contact us immediately. AUSTIN (ID # T222) This is a unique opportunity to purchase a practice located in a busy retail center in Austin. The practice is ideal for a doctor or company looking for a large facility to establish a multiple doctor and hygienist office for less than the cost of building out a shell space and equipping a startup. The practice has a total of 18 plumbed operatories with 6 operatories currently equipped. The practice revenue was on pace to be around mid-6 figures in 2013 with only one doctor producing. Serious inquiries only as this is a unique opportunity not suited for most solo practition s looking to acquire a practice. CENTRAL AUSTIN (ID #T225): Located in a very desirable area of north central Austin, this established fee-for-service general family practice offers a lot for an incoming denti t. The practice is located in a 1,500 sq ft foot, 4-operatory facility within a small 2-story professional condominium building. The practice boasts a commi ed and well-trained sta , strong hygiene program, solid active patie t base and gross annual revenues averaging mid-6 figures over the last 3


ADVERTISING BRIEFS years. While the practice is a strong opportunity as-is, an incoming owner doctor would have ample opportunity to grow the practice given that the current owner is not accepting any PPOs, relies only on word-of-mouth referral to generate new patie t flow and is referring a significant amount of specialty work out of the office. WACO AREA (ID #T189): This small, established family practice is an excellent opportunity for someone looking to practice in a growing rural community with very little competition This office has solid upside potential considering that the owner doctor is only working part-time. Revenue for the past 3 years has averaged low 6 figures. Contact McLerran & Associates: David McLerran or Brannon Moncrief in Austin, 512-900-7989; San Antonio, 210-737-0100. Practice sales, appraisals, buyer representation, and lease negoti tions. To request more information on our listings, register at dental-sales.com. AUSTIN: A well-established pediatric practice is seeking an energetic dedicated full-time pediatric denti t. We have an extensive client base with continued growth. Our office is a leader in all aspects of pediatric denti try including sedation and anesthesia denti try. We have 3 offices with state-of-the art technology and a highly trained support sta . We are looking for the right fit for our practice. Ideally, someone who is looking for a longterm opportunity. New grads are welcome to apply. Please e-mail resume to tal@austinchild ensdenti try.com. AWESOME PRACTICE IN EAST TEXAS FOR SALE: SLH is looking for a qualified associate or new graduate, with an option to buy, that would like the opportunity to immediately transition into a general denti try practice in this growing town of East Texas. The owner is willing to stay for a negoti ted amount of time if necessary to ensure a smooth transition. The location of the practice is near the hospital in a beautiful scenic area surrounded by many professional buildings. The staff is excited and ready for a new member and future owner that will allow

their current denti t to pursue other opportunities. The office space is 1,500 square feet with 4 treatment rooms equipped, 2 private offices, and 6 highly experienced employees. The new practitioner will lease space from the group dental practice. The group practice occupies a portion of the building complex and is looking to transfer ownership of the patie t base and/or equipment within six months. Listing #3050 CB. Pictures can be made available. For more information contact our office at 972562-1072 or email sherri@slhdentalsales.com or visit our website at www.slhdentalsales.com. COLORADO DENTAL PRACTICE FOR SALE: Located in southwest Colorado near the San Juan mountains. Ski, fly fish, hike, and hunt. It’s all in your backyard. Established fee-for-service restorati e practice with state-of-theart equipment and furnishings is waiting for you in this mountain town community. Collecting mid-6 figures with the potential to do way more. Owner is relocating to pursue a new phase in his dental career. Get of the Texas heat and the rat race and enjoy real living again. Practice is att acti ely priced to sell. Email inquiries to t1h2oyd3@ yahoo.com. DALLAS / FORT WORTH: Area clinics seeking associates. Earn significantly above industry average income with paid health and malpractice insurance while working in a great environment. Fax 312-944-9499 or e-mail cjpa erson@ kosservices.com. DALLAS AREA: New and beautiful general denti try practice on I-30 near Rockwall. Over 5 years of clinical experience required. Perfect for denti ts who refer endo! Pay based on collections. PPO and Medicaid accepted. M-F 2:00 PM. - 8:00 PM and Saturdays available. Visit www. mockingbirddentalgroup.com.

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ADVERTISING BRIEFS DDR DENTAL™ — AUSTIN: GENERAL PRACTICE — Wellestablished Austin practice in terrific north Austin location. Well designed and decorated office. Fronts high-traffi Hwy 182. Four operatories in use and plumbed for 4 more. Mid-6 figure gross and high net income. Free-standing building also available for sale. Contact Chrissy Roehm Dunn at 800-930-8017 or view the practice at DDRDental. com (DDR Dental Trust™ Member). DDR DENTAL™ — SOUTHWEST HOUSTON (FONDREN): GENERAL PRACTICE – High-7 figure gross with mid-high-6 figu e net income. Four fully-equipped operatories on small inexpensive footprint. Well-established patie t base. Contact Chrissy Roehm Dunn at 800-930-8017 or view the practice at DDRDental.com. DDR DENTAL™ — PANHANDLE TEXAS: ORAL SURGERY PRACTICE — Seven figure gross with expected high-6figure net income. Four fully-equipped operatories with surgical suite. Option to purchase building also available. Wellestablished referral and patie t base. Contact Chrissy Roehm Dunn at 800-930-8017 or view the practice at DDRDental.com. To obtain timely information about the practices that we have for sale and recently sold, please visit our website at DDRDental.com. DENTISTS: A practice of 1 year looking for a BC/BE pediatric denti t to come on board as employee with possible buy-in. This is an all pediatric denti ts’ office. You would be working next to a BC pediatric denti t. Good terms with great pay and work hours. Must be able to get Board Certified within 1 year. OR cases done at El Paso’s Children’s Hospital. Excellent opportunity. Contact 719671-5617 or tparco@dentalquestions. om. DFW AREA: Seeking general denti ts and specialists. Our offices are located in the Dallas / Fort Worth area. We are looking for caring, energetic associates. New graduate and experienced denti ts welcome. We offer benefits, a helpful

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working environment and an opportunity to grow. We accept most insurance and Medicaid. Please submit your resume via e-mail to jennifer@smileworkshop.com or call our office at 214-757-4500. EAST TEXAS: Well-established dental practice seeks caring, proficie t, and motivated denti t for associate employment. Our office is located in a mid-sized town with abundant outdoor activities including hunting and fishing and a “small town” atmosphere. We offer all phases of denti try. Interested candidates should e-mail correspondence and resume to mloon242@aol.com. EDINBURG: Falcon Denti try PA dba Falcon Dental Center seeks denti t in Edinburg. Doctor of Dental Surgery degree required. Texas dental license required. Qualified applications may submit resume directly to Atlantis Gloria Moya, office manager, via fax at 956-287-4926 or via email at falcondenti try@gmail.com. EL PASO: Full-time position for a general denti t. Do not waste your best years at dead end jobs. Great earning potential and future partnership option. Affordable El Paso Dental is looking for a Texas-licensed denti t to work fulltime in our office in El Paso. Applicant must be licensed in the state of Texas and have 1 year of experience. If interested please submit a resume with an accurate contact number and email address to the following: drdarj@gmail.com. EL PASO: We are hiring a skilled and compassionate denti t to join our stable and successful practice. We are seeking a highly professional denti t with a knack for general denti try. Prospecti e candidates must be dynamic, fun loving, and looking for a long term commitment. Our practice is highly producti e a ording our providers an opportunity to a ain competi e compensation. If interested, please forward your CV to anne e@vistahillsfamilydental.com.


ADVERTISING BRIEFS EL PASO: Well-established general practice of over 30 years seeking full-time general denti t associate. Associate would be sole denti t at one of 2 office locations with full staff including hygienist. Income opportunity well above average. Professional opportunity even greater. Send resume to drartbejarano@gmail.com. ENDODONTIST -- FULL TIME, KILLEEN: Carus Dental, established in 1983 in Austin, has always been commi ed to the traditional doctor-patie t relationship and to the highest quality in dental care and service. We currently have approximately 48 doctors on staff across our 21 practices in Austin, Houston and Central Texas. We offer dental services in general denti try, oral surgery, orthodontics, pediatric denti try, endodontics, periododontics and prosthodontics in some or all of our practices. Carus Dental has been accredited by the Accreditation Association of Ambulatory Health Care since 2000. We offer a competi e salary and excellent benefit package including a 401k, health insurance and a professional work environment. To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi.com and www.carusdental. com. If interested, please send CV and cover le er to kateanderson@amdpi.com. GALVESTON: Well-established, successful practice of 35 years needs FT associate denti t for FFS/PPO practice. Experienced sta , new equipment, Galveston. Senior owner loves to teach sedation, implants, and other surgical procedures. No Medicaid, No DHMO practice in 6 ops, 2 surgical suites, all operatories computerized with digital X-ray and intra-oral cameras; digital panoramic X-ray; paperless charts for easy documentation. Visit www. todaysdenti trytexas.com. The Galveston area is just south of Clear Lake 25 minutes which has planned communities with superior schools, multiple educational, recreational and cultural venues as well as access to all of the Houston cultural and sport venues, shopping and restaurants. We

are minutes away from all types of water sports including several large marinas. http:/ goo.gl/maps/lWkF. Possibility of buy-in and partnership possible a er an interim term. Interview today! E-mail CV to kkcarroll10yahoo.com or call 832-385-8875. GARY CLINTON DENTON AREA GENERAL PRACTICE FOR SALE: D-1 Denton Practice. Retiring denti t owns the facility. Five operatories; outright sale with transition; no low fee plans. Buy at a great price and build a successful practice. Contact Gary Clinton, 1-800-583-7765. GARY CLINTON HOUSTON PRACTICE FOR SALE: H-2 Northwest Houston in Lake Houston area. Well-established practice with high 6-figu e estim ted gross on 3 days. Excellent recall. This is a 7-figu e practice waiting to happen. Trust your life’s work to the most experienced appraiser/broker. For over 40 years, you have seen the name, Gary Clinton, working as a management consultant, appraiser, consultant, and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser, member of The Institu e of Business Appraisers, Inc. Call Gary Clinton confide tially at 1-800-583-7765. ORAL SURGERY PRACTICES: D-1 Dallas area. Very nice office; 2-day-a-week practice; excellent referral base. Under served area. SA-1 San Antonio Fast Growing Outlying Community. Lakes, hill country beauty; highly rated schools. Flexible transition. Will phase out PRN. High net on 4 days a week. Mid-sized community. W-1 West Texas central area. Oral surgeon retiring; fl xible transition. Seller phase out. High net. Mid-sized community. All are confide tial. Gary Clinton, oral surgery broker/appraiser, 1-800-583-7765.

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ADVERTISING BRIEFS GARY CLINTON DALLAS PRACTICE near Trinity River greenbelt for sale. Doctor retiring for health reasons; well-established 30+-year-old practice. High demand. Trust your life’s work to the most experienced appraiser/ broker. For over 40 years, you have seen the name, Gary Clinton, working as a management consultant, appraiser, consultant, and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser, member of The Institu e of Business Appraisers, Inc. Call Gary Clinton confide tially at 1-800-583-7765. GARY CLINTON PANHANDLE AND WEST TEXAS PRACTICES FOR SALE. W-1 7-figu e collections, high net on 4 days a week. Only denti t in small community. Progressive family denti t retiring to travel. Upgraded equipment. Nice office. Doctor will sell or lease building. Trust your life’s work to the most experienced appraiser/ broker. For over 40 years, you have seen the name, Gary Clinton, working as a management consultant, appraiser, consultant, and sales broker of general dental and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser, member of The Institu e of Business Appraisers, Inc. Call Gary Clinton confide tially at 1-800-583-7765. GARY CLINTON FORT WORTH area, 2 excellent practices for sale. Well-established adult restorati e practices. Doctors are both retiring; both in great southwest area of Fort Worth. Trust your life’s work to the most experienced appraiser/broker. For over 40 years, you have seen the name, Gary Clinton, working as a management consultant, appraiser, consultant, and sales broker of general dental

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and specialty practices in Texas. I have buyers for all metro areas of Texas. Knowledgeable buyers are willing to pay the fair market value in growth areas commanding higher values. My certified appraisals use comparables from Texas practices in the same or similar parts of Texas. Senior appraiser, member of The Institu e of Business Appraisers, Inc. Call Gary Clinton confide tially at 1-800-583-7765. GARY CLINTON PEDO/ORTHO OR GENERAL PRACTICE OFFICE SPACE: This is the spot to be. Close to Exxon’s new home office which has 15,000 employees. One space is totally finished out for pedo/ortho. One closest to headquarters is the last space; 2,800 sq ft. Build a practice from start that is a sure bet to be very successful. Call Gary Clinton, 214-503-9696. HOUSTON AND SAN ANTONIO: Care For Kids, a pediatric focused practice, is opening new practices in the San Antonio and Houston area. We are looking for energetic full-time general denti ts and pediatric denti ts to join our team. We offer a comprehensive compensation and benefits package including medical, life, long- and shortterm disability insurance, flexible spending, and 401(K) with employer contribution. New graduates and denti ts with experience are welcome. Be a part of our outstanding team, providing care for kids of Texas. Please contact Anna Robinson at 913-322-1447; e-mail arobinson@amdpi.com; FAX: 913-322-1459. HOUSTON/CLEAR LAKE — DENTAL OFFICE: In high visibility smaller professional building at highest traffi corner location in adjacent family oriented, high income master planned community. Adjacent CVS, nearby schools, retail and office centers, NASA and other long term tenants (UTMB orthopedic and urgent childcare center, podiatrist and chiropractor) drive patie t traffic Nice finishes and all plumbing and electrical in place for 6 or more operatories, offices and consult rooms. Lease incenti es, negotiable terms. Dwight Donaldson,


ADVERTISING BRIEFS Monument Real Estate, 281-240-0077, ddonaldson@ terramarktx.com. HOUSTON-AREA PRACTICE OPPORTUNITIES! MCLERRAN & ASSOCIATES-PRACTICE SALES OF TEXAS: NEW! NORTH OF HOUSTON: Established general cosmetic practice located in one of the fastest growing communities in the Houston area. The turnkey, 5-operatory facility has a comfortable, cozy ambiance, equipment that is in very good condition, and room for expansion and solid growth potential (#H234). NEW! SOUTHWEST OF HOUSTON: Established general practice with a highly visible location, 4 operatories, strong employment base, and a healthy new patie t flow with majority PPO/FFS. The owner is looking for an experienced practitioner that will exhibit an ownership attitude in order to maximize income for both parties. Partial buy-in opportunity will be available in the future for the right doctor (#H93). NEW! NORTH OF HOUSTON: This general family practice was started in 2008 when the seller purchased the existing build-out and equipment of an established denti t who relocated his practice. Upgrades include digital radiography (intraoral and panoramic) and flat screen TVs in the operatories. With an active base of over 800 patie ts, new patie t fl w of 25 patie ts per month, a visible retail strip center location, and opportunity for expanded office hours, growth potential is solid. Value acquisition with strong upside potential (#H236). SOUTHWEST HOUSTON: PPO/ FFS practice, visible retail location on main thoroughfare in growing southwest family oriented area. With low overhead, a recently remodeled interior, 3 operatories, and 1,100 sq ft, the practice represents a value purchase with signifi ant upside potential. Recent website and social media pla orm development will also allow the buyer to e ecti ely reach out to the community to further enhance patie t flow. Very limited schedule for the owner and signifi ant outbound referrals for endo, perio, oral surgery, and orthodontics (#H243). NORTHWEST HOUSTON: This general and orthodontic denti try practice is located on

a well-traveled road in the Northwest Houston/Hockley area. The area is expected to grow tremendously over the next few years with the expansion of major roads in the area. The practice sees approximately 30 new patie ts per month and hygiene produces 27% of production. With a strong hygiene department, high new patie t fl w and low overhead, the practice is set for continued profi ability and growth (#H231). PRICE REDUCED! UPPER WEST GALVESTON BAY: Profi able General practice located in a highly visible office building in the heart of a vibrant oil and gas commercial center and community. Three fully equipped operatories, strong hygiene revenues, and over 1,100 active patie ts (#H194). NEW! NORTHEAST OF HOUSTON: Established, extremely profi able general practice in single tenant, 3,400 sq ft professional building; 5 plumbed and equipped operatories, steady level of annual collections over past 4 years (#H232). NORTHWEST HOUSTON: This general denti try practice has established for 11 years in the Northwest Houston area. The practice is located in a Kroger and CVS Pharmacy shopping center with great visibility and high foot traffic. The practice is conveniently located close to 3 major highways in the Houston area (#H226). GALVESTON: Established feefor-service practice, collections have been increasing in recent years and are consistently over 6 figures. With a solid economic base, the practice enjoys a strong recall system, an experienced and stable sta , and has seen over 2,500 patie ts in the last 24 months. The facility is free standing and has 8 equipped operatories with room for expansion (#H161). NORTHWEST HOUSTON Ăą ASSOCIATE POSITION WITH FUTURE BUY-IN: Established general denti try practice is located near a high traffic intersection in the booming Northwest Houston/Copperfield area. Revenues in low-7 figures a strong hygiene department, and a very healthy new patie t flow, the practice is set for continued profi ability and growth. (#H225) SOUTHEAST HOUSTON: Well established general practice, located in highly visible shopping center, 5 operatories, stable patie t base, room for expansion, comfortable dĂˆcor (#H197).

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ADVERTISING BRIEFS SOUTHWEST OF HOUSTON: Established general practice, 4 operatories, stable blue collar patie t base, petrochemical economic base, 2,000 sq foot building available. Doctor working only part-time (#H174). To see our most upto-date listings, please go to dental-sales.com. Contact McLerran & Associates in Houston: Tom Guglielmo, Patrick Johnston, Mac Winston, 866- 756-7412 or 28362-1707, houstoneasttx@de tal-sales.com. Practice sales, appraisals, buyer representation, and partnership counseling. LAREDO / MCALLEN: If you are looking for a great opportunity to join an amazing team with ownership potential and minimal administrati e responsibility, this is it! We are looking for a motivated and personable individual with a positive attitude who is passionate about working with children. Our 3 locations offer a modern environment with all digital records and X-rays. We offer in-office oral conscious sedation and general anesthesia at local hospitals. Our emphasis is on exceptional patie t service, team member development and having a lot of fun. Our compensation package includes a percentage of collections with a daily guarantee, plus 401k, medical, vacation, and holidays. Our mission is to positively impact the lives of our patie ts, their families and our team members. If you would like to be a part of this amazing team please call Dr Guzman at 956-607-0732 or email drguzman@littlehe oesdenti try.com. LAREDO: We are looking for a pediatric denti t for a rapidly growing practice. Strong referral sources. Hospital cases performed twice a week at local hospital. State-ofthe-art practice with digital X-rays and charts. If part-time, then denti t can fly in to see patie ts and still maintain living at their current city. Partnership in future is an option if candidate interested. Please email t2tpdlaredo@ gmail.com.

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LONGVIEW PEDIATRIC PRACTICE SEEKING FULL-TIME ASSOCIATE: Sherri L. Henderson & Associates, LLC is looking for a qualified associate to transition into an acti e pediatric dental practice. The associate will be working with a knowledgeable staff and a great new patie t flow. This practice is dedicated to performing high quality dental care to the children and adolescents of the surrounding communities. The denti t/owner established the practice 14 years ago, and offers a future opportunity to buy-in. This beautiful pediatric practice is 5,000 sq ft, with 4 doctor chairs and 4 hygiene chairs, plus a quiet room and a new patie t room. A full-time schedule of 4.5 days per week is offered, with salary based on 40% of production. Health insurance and benefit plans are negotiable. Listing #3435. Photos available. For more information, please contact our office at 972-562-1072, email sherri@slhdentalsales.com, or visit our website at www.slhdentalsales.com. MIDLAND: One of the fastest growing cities in Texas needs a dynamic, caring, patie t-focused denti t to join our growing practice. Associate and/ buy-in opportunities are available. Please contact Dr Britt Bostick, DDS, at bbost35821@aol.com or call 806-438-5745. NORTH TEXAS: Pediatric denti t needed for busy north Texas practice. Enjoy life in Sherman, Texas, a familyoriented city with the convenience just 1 hour north of Dallas, but without the hustle and bustle of the big city! Excellent practice opportunity for motivated and nurturing pediatric denti t seeking full-time associate with potential for partnership. Practice has a great reputation and is commi ed to providing quality comprehensive care for our patie ts and families in a fun and relaxed atmosphere. State-of-the-art facility with highly trained and dedicated sta . Competi e compensation and benefits. Fee-forservice, limited Medicaid. Must possess high personal standards, strong work ethic, excellent technical and communication skills, and be willing to treat the full range


ADVERTISING BRIEFS of pediatric dental patie ts. Opportunities for in office conscious sedation, IV sedation and hospital denti try. Please email resume/CV to bth1@cableone.net. OPPORTUNITY TO TRANSITION INTO A BUSY ORAL SURGERY PRACTICE within a multi-disciplined practice. Present oral surgeon is retiring. Practice is private fee for service. New i-CAT (3D) in office. For information contact Paul Kennedy, DDS at pkennedy@gte.net or 361-960-6484. ORAL SURGEON NEEDED. Oral surgeon will be busy for a full day or two with implant and bone grafts. Competi e pay. Flexible in scheduling. Please call 361-387-3442. PEDIATRIC DENTIST, PART TIME: Carus Dental, established in 1983 in Austin has always been commi ed to the traditional doctor-patie t relationship and to the highest quality in dental care and service. We currently have approximately 48 doctors on staff across our 21 practices in Austin, Houston and Central Texas. We offer dental services in general denti try, oral surgery, orthodontics, pediatric denti try, endodontics, periododontics and prosthodontics in some or all of our practices. Carus Dental has been accredited by the Accreditation Association of Ambulatory Health Care since 2000. We o er a competi e salary and excellent benefit package including a 401k, health insurance and a professional work environment. To learn more about American Dental Partners and Carus Dental please visit us at www.amdpi. com and www.carusdental.com. If interested, please send CV and cover le er to kateanderson@amdpi.com. PEDIATRIC PRACTICE FOR SALE: Very large private pediatric practice in large metropolitan area in Texas, mix of PPO and Medicaid in a beautiful, free-standing 5,000 sq ft building with 10 chairs. Highly profi able private practice established 30 years. Texas Practice Transitions, Inc. Rich Nicely has been serving Texas denti ts since 1990. Visit www.tx-pt.com or call at 214-460-4468; Rich@tx-pt.com.

PRACTICE FOR SALE SOUTHWEST OF FORT WORTH in fast growing area. Average Gross; 6 operatories; Excellent Lease. Seller is relocating. Need to move quickly on this one. DFW 214-503-9696. WATS 800-583-7765. READY TO SELL — CORPUS CHRISTI AREA: Sherri L. Henderson & Associates. The DDS is relocating to another city. This cosmetic and general denti try practice was established in 1982 in a professional office complex with 1,400 sq ft and 3 existing treatment rooms. This location would make a great place for a start-up or satellite practice and it has plenty of space next door for expansion. The location is on one of the busiest streets with access to Padre Island Drive. This is a cash basis practice with a dedicated loyal staff and great revenue potential. The current owner has extensive experience with TMJ and sleep apnea and would be willing to return to the practice periodically if the new owner was interested. Listing #3070. Pictures available. Contact 972-562-1072 or email sherri@slhdentalsales.com. Visit www.slhdentalsales.com. SAN ANTONIO NORTH WEST: Associate needed. Established general dental practice seeking quality oriented associate. New graduate and experienced denti ts welcome. GPR, AEGD preferred. Please contact Dr Henry Chu at 210-684-8033 or versed0101@yahoo.com. SAN ANTONIO: Pediatric denti t. Well-established and growing pediatric practice is seeking a caring and energetic associate for a full-time and part-time position. We offer excellent production with incredible earning potential, vacation and other benefits. New graduates are welcome. Please submit your resume to velezluke@yahoo.com. SLH DENTAL SALES (SHErri L. HENDErSoN & ASSociATES): Consulting and staging for your transition! Let us help you make a transition plan. We can analyze the market, review your current patie t base, secure the sta , spruce up the office space, and much more. We

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ADVERTISING BRIEFS specialize in practice transition consulting and can assist you in a plan to help you create all the right conditions to begin that step from retiring to starting up a new practice. Our team has decades of hands-on experience in the dental market place as practice owners, employees, and management advisors. ASSOCIATES, PARTNERS AND BUYERS AVAILABLE. Are you seeking an associate, partner, or buyer? SLH has qualified candidates ready in all parts of Texas looking for your specific practice profile. There are many graduates as well as very experienced denti ts looking for the opportunity to transition into your already established practice. These denti ts have great people skills, case presentation experience and can be a very valuable and reliable addition to your bottom line. CONTACT US. If you are unsure about the right timing or simply would like to talk about the opportunities, call us today for a complimentary consultation in person or by telephone. All contact with you is strictly confide tial. Call on our experience to assist you in making that transition dream become a reality. Call 972-562-1072 or email sherri@slhdentalsales.com, website slhdentalsales.com. SUGAR LAND, CYPRESS, PEARLAND AND THE WOODLANDS: Full- and part-time positions available. Well established and rapidly growing practices that offer great financial opportunity. High income potential and future equity position. E-mail CV to Dr Mike Kesner, drkesner@ madeyasmile.com. TEXAS PRACTICE TRANSITIONS, INC. Rich Nicely has been serving Texas denti ts since 1990. Visit www. tx-pt.com or call at (214) 460-4468; Rich@tx-pt.com. PEDIATRIC: Very large private pediatric practice in large metropolitan area in Texas, mix of PPO and Medicaid in a beautiful, free standing 5,000 sq. ft. building with 10 chairs. Highly profi able private practice established 30 years. HUNTSVILLE: Medium sized full fee patie t base; Digital x-rays; Free standing building; long term staff; 4 days of hygiene per week. ARLINGTON: Highly visible large

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sized practice and building on major road; 6 equipped treatment rooms; digital x-rays; 100% paperless; Mix of PPO and DHMO patie ts. EAST TEXAS: Small full fee patie t base. Great building with water views from each of the 4 treatment rooms. VICTORIA: Medium sized practice; PPO patie t base; free standing building, long term staff; doctor refers out lots of denti try. MIDLAND: Large sized practice; full fee patie t base; Digital x-rays; Modern free standing building; long term staff; EL PASO: East side; Large practice; full fee patie t base. EL PASO: West side; medium sized practice; mostly PPO patie t base. OKLAHOMA: 1 hour outside OKC; Large full fee office, 5 treatment rooms, fantastic building; urgent sale situation THE HiNDLEY GroUP, LLc — DENTAL PrAcTicE SALES: NEW LISTING! NORTH HOUSTON, ENDO PRACTICE: Highly regarded Endodonti t selling well established practice due to family relocation. $1 Million plus in revenues on 3 days per week with very strong profit margin. Friendly, knowledgeable sta . NEW LISTING! THE WOODLANDS, TEXAS, GENERAL PRACTICE: This 44 year old practice has been located in a wonderful Woodlands location for the past 9 years! This general dental practice is open 4 4 days per week, operating from 2,395 sq ft with 3 fully equipped fully digitized operatories. Upper-Middle class patie t demographic, FFS with mostly insurance and some cash revenues. Lower revenues due to lack of marketing and declining health of owner. Substantial upside opportunity! Must Sell! NEW LISTING! SOUTH HOUSTON, ORTHO PRACTICE: Retiring orthodonti t desires to sell remaining patie ts, equipment and centrally located office condominium of 1,160 sq ft. Optimum purchaser candidates would include: an orthodonti t wanting a larger location, an orthodonti t desiring a satellite location, or an orthodonti t wanting to grow a practice in this afflu t Houston area. Perfect for a new resident graduate wanting to be in the strong Houston economic environment! WEST HOUSTON GENERAL DENTAL PRACTICE FOR SALE: Small general dental practice


ADVERTISING BRIEFS with high percentage restorati e revenues. Average 8 new patie ts per month. 2 fully equipped operatories with 1 additional hygiene room and another room plumbed for expansion. Digital Pano. Same location for 13 years. Cash and Insurance revenues. Motivated seller! Excellent opportunity for start up at low cost. SOUTH OF HOUSTON, TEXAS COASTAL PLAINS GENERAL DENTAL PRACTICE FOR SALE: Well-established for 28 years and in same location for last 17. Strong revenues and healthy profit margin on 4 days per week! 2500 sq ft building with 4 fully equipped operatories also for sale. Experienced, dependable sta . Great opportunity! WEST CENTRAL TEXAS GENERAL DENTAL PRACTICE: 25-year-old well-established family dental practice for sale. Open 4.5 days per week. 2400 sq ft building with 4 fully equipped operatories. 3 direct digital X-Ray units in operatories plus numerous other upgrades to equipment and building, which is also for sale. Steady new patie t growth and outstanding sta . NORTHWEST HOUSTON GENERAL DENTAL PRACTICE: Well established, very traditional practice with moderate fee for service revenues and healthy profit margin. Open 4 days a week. 1,200 square foot facility with 3 fully equipped operatories. Doctor retiring. NORTH OF HOUSTON GENERAL DENTAL PRACTICE: Very well established practice in the same location for 31 years. Moderate cash revenues with some PPO insurance. Practice open 4 days per week. 2,200 sq ft with 2 fully equipped operatories and 3 additional plumbed. Loyal, experienced sta . Doctor is retiring. Call 800-856-1955 or email kate@ thehindleygroup.com THE HINDLEY GROUP, LLC DENTAL PRACTICE SALES: NEW LISTING! WEST HOUSTON PERIODONTAL PRACTICE FOR SALE: Located between Beltway 8 and Highway 6 off I-10, this practice has been in business for 33 years on the west side of Houston with 13 years at this location. They currently have 1,500 patie ts with 25 new patie ts added per month for recall or treatment. The suite is a lease, available for renewal every 5 years, with 2200

square feet. This space includes 6 fully equipped operatory rooms, 3 recovery rooms, x-ray room, reception room, business office, private doctorsĂ­ office, staff area and 2 restrooms. Using direct digital to provide immediate images using PCH Dental Software, PerioLase MVP7 with the LANAP protocol and PreXion 3-D Imaging Scanner with transferable licensing. Office hours are 4.5 days per week with 1 office manager, 2 full-time surgical assistants, 1 part-time hygienist, and 1 part-time assistant manager. Very loyal and knowledgeable sta . NEW LISTING! SOUTHWEST HOUSTON GENERAL PRACTICE FOR SALE: Located inside the beltway in Bellaire, this is a very wellestablished practice in business for 55 years and in the same location for the last 22; 1,188 sq ft of practice space with 3 fully-equipped operatories. Additional 471 sq ft upstairs. Practice open 4 days per week, 9:00 AM-5:00 PM. Generating moderate revenues, the practice has 1,300 acti e patie ts with 13 new patie ts joining per month. Experienced sta . Doctor is retiring and is anxious to e ect a transition to a well-qualified general denti t. This is a wonderful in-town practice at a most reasonable price and a great pla orm from which to build for the future! Doctor would also like to sell the real estate with the practice. NEW LISTING! HOUSTON-CLEAR LAKE, ORTHO PRACTICE: Close to intermediate school and Johnson Space Center. Retiring orthodonti t desires to sell remaining patie ts, equipment and centrally located office condominium of 5,101 sq ft. Optimum purchaser candidates would include: an orthodonti t wanting a larger location, an orthodonti t desiring a satellite location, or an orthodonti t wanting to grow a practice in this afflu t Houston area. Perfect for a new resident graduate wanting to be in the strong Houston economic environment! WEST HOUSTON GENERAL DENTAL PRACTICE FOR SALE: Small general dental practice with high percentage restorati e revenues. Average 8 new patie ts per month; 2 fully-equipped operatories with 1 additional hygiene room and another room plumbed for expansion. Digital Pano. Same location for 13 years. Cash and insurance revenues. Motivated

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ADVERTISING BRIEFS seller! Excellent opportunity for start up at low cost. SOUTH OF HOUSTON, COASTAL PLAINS GENERAL DENTAL PRACTICE FOR SALE: Well-established for 28 years and in same location for last 17. Strong revenues and healthy profit margin on 4 days per week; 2,500 sq ft building with 4 fully equipped operatories also for sale. Experienced, dependable sta . Great opportunity! WEST CENTRAL TEXAS GENERAL DENTAL PRACTICE: 25-year-old wellestablished family dental practice for sale. Open 4.5 days per week; 2,400 sq ft building with 4 fully equipped operatories; 3 direct digital X-Ray units in operatories plus numerous other upgrades to equipment and building, which is also for sale. Steady new patie t growth and outstanding sta . NORTHWEST HOUSTON GENERAL DENTAL PRACTICE: Well-established, very traditional practice with moderate fee-for-service revenues and healthy profit margin. Open 4 days a week; 1,200 sq ft facility with 3 fully-equipped operatories. Doctor retiring. NORTH OF HOUSTON GENERAL DENTAL PRACTICE: Very well-established practice in the same location for 31 years. Moderate cash revenues with some PPO insurance. Practice open 4 days per week; 2,200 sq ft with 2 fully equipped operatories and 3 additional plumbed. Loyal, experienced sta . Doctor is retiring. Call 800-856-1955 or email norton@thehindleygroup.com. WACO: Great associate opportunity. Waco practice looking for motivated associate with a desire to join a PPO/feefor-service practice. Great pay, great work environment with two other denti ts and top notch sta . Please contact Dr Johnson at 435-237-2339 or email at johnson.2978@ gmail.com. WE ARE SEEKING A FULL-TIME GP to join our state-of-theart, fast-growing, digital office. Once you join us, you will have the full support of our loving and friendly staff and management, as well as the newest dental equipment. We use eletric handpieces, isolites, dental vibes, digital

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intra-oral cameras and digital x-rays, as well as many more of the latest dental technology. We are in full compliance with the latest requirements by the TSBDE, with excellent growth potential. Plase feel free to contact me if you have any questions. Our offices are very laid back, family-friendly environment. Please forward your CV to bwolfrodeodental@gmail.com

OFFICE SPACE ABILENE: Two- to 4-operatory stand-alone dental office with all equipment included; digital x-ray and pano. Call 325-762-0444 DALLAS AND ROCKWALL: Orthodontic or other specialty office or lease to share with owner. Furnished and equipped. Dallas office is 4,000 sq ft in Lake Highlands area with 2,500 sq ft leasable residence above. Rockwall office is 1,800 sq ft in antique building and furnishings. Email rcppc@sbcglobal.net. HOUSTON / LEAGUE CITY: Medical/office space available for lease in a stellar location, right outside the largest school in Texas with 4,200 students on campus. In a fast growing area with a lot of young families, located close to the waterfront, boardwalk, Gulf Coast beaches, Houston downtown, NASA and Hobby Airport. Home to one of the state’s top rated Independent school districts, stunning yet a ordable waterfront neighborhood developments, NASA, BOEING, UTMB. Contact Vijay Bhagia 832-618-0652 or eduvillageland@gmail.com. NORTH TEXAS DENTAL PRACTICE OPPORTUNITIES: Lewis Health Profession Services has multiple career opportunities available in the greater Dallas/Fort Worth area. Practices for sale, associate opportunities, finished out dental offices, and specialty practice opportunities. Lewis Health Profession Services has 30 years experience


ADVERTISING BRIEFS in dental practice transitions, with over 1,000 successful transitions completed. Denti try is our only business. We confide tially deal with all clients. Lewis Health Profession o ers seller representation, buyer representation, opportunity assessments, associate placement and strategic planning services. Please check out our web site at www.lewishealth.com for current opportunities. For additional information, contact Dan Lewis at Lewis Health Profession Services 972-437-1180 or dan@lewishealth. com. ORTHO OFFICE SPACE FOR LEASE. Are you a new orthodonti t wanting to start a practice but can’t a ord a full-time lease? Are you an established orthodonti t who would like a satellite office? I am a pediatric denti t in Pinehurst. My office is usually closed Friday to Sunday. I have a beautiful 5200 sq ft office that would be a great option for an orthodonti t. Lease fee would be negotiable depending on how many days per month you need. Orthodonti t would be responsible for all equipment, supplies and sta . You may view my office at stagecoachdental.com. If interested, please email me at drcoe@stagecoachdental.com. SAN ANTONIO FOUR-OPERATORY PRACTICE FOR SALE: We have outgrown the space, looking to relocate. Space is perfect for a specialist. Transition available. The space is located right off the Dominion Country Club golf course in San Antonio. Very modern, tranquil, pleasant location, granite countertops, plumbed for nitrous, second floor with balcony. Please contact Dr Stra on at 210-687-1150 or e-mail tiffini@dominiondentalspa.com. SEGUIN: Orthodontic office space for lease in. Office was phased down when orthodonti t reti ed. Office is equipped and functional. Great for a start up or a satellite location. Email inquiries to lmassadds@gmail.com.

f o r SALE DENTAL PRACTICE FOR SALE Retiring denti t offering 36 year-old one-chair practice with original equipment. Great potential for younger denti t who wants to work full-time. Approx 900 sq ft with adequate space for 2nd operatory. One employee with 36-years experience in this office. Located in Muenster TX, a quaint small town, at 204 N. Main #C. About 70 miles north of Dallas near the Red River. Two outstanding school systems both K-12. One private and one exemplary public. Two football and basketball teams. Very good hospital. Home of “German Fest” a widely-known yearly celebration held each April in the New Heritage Park. (O) 940-759-2889 (H) 817-4881207 Contact email: brnrd.luke@gmail.com EQUIPMENT FOR SALE: New handheld portable X-ray unit. New intraoral wall X-ray unit, new mobile X-ray on wheels. New chairs/units operatory packages, new implant motors. Everything is brand new, with warranty. Contact nycfreed@aol.com. IMTEC IMPLANT SYSTEM. $600, 24 implants, torque wrenches, surgical items and adapters, sterilization kit, instruction disk. Never used. Integral implants. $200, 11 coated implants and surgical drills, placement and retrieval instruments. $500 (regularly $1,500), 4 Misch basic setup physics forceps. Contact Dr. James Grogan, 469-585-9622, docharleyday@sbcglobal.net.

INTERIM SERVICES HAVE MIRROR AND EXPLORER, WILL TRAVEL: Sick leave, maternity leave, deployment, vacation or death, I will cover your office. Call Robert Zoch, DDS, MAGD at 512263-0510 or drzoch@yahoo.com.

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ADVERTISING BRIEFS OFFICE COVERAGE for vacations, maternity leave, illness. Protect your practice and income. Forest Irons and Associates. “Denti ts Helping Denti ts Since 1983.” Call 800-433-2603 (EST). Visit www.foresti ons.com.

MISCELLANEOUS DENTIST/CONSULTANT: PT (min 4 hrs/day) for national claim review company. Work form your home or office. Must have active TX dental license. Fax resume to 212686-4703. EXTRACTION/ORTHODONTIC CE: September 26-27 in Minneapolis; 18 hours CE Dr. DePaul will teach PowerProx Six Month Braces Dr. Fletcher and Murph will teach Extractions using Pig Jaws. Dr. McCall will teach Immediate Dentures $1894 if signed up by May 1st $2294 a er May 1st sixmonthbraces@hotmail.com drtommymurph@ yahoo.com

PLACE A CLASSIFIED AD IN THE

TEXAS DENTAL JOURNAL It’s a member benefit! Reach more then 9,000 of your dental colleagues.

COST PRINT: $40 for the first 30 words, 10 cents per word after that. ONLINE: $10 a month (no word limit). $60 one-time additional fee to post online immediately.

CONTACT For more information, please visit tda.org or contact Nicole Scott, Managing Editor at 512-443-3675 ext 124 or by e-mail nicole@tda.org.

IV SEDATION TRAINING FOR DENTISTS: This “miniresidency” includes 60 hours of didactic and the administration of IV sedation to at least 20 dental patie ts while supervised. Program meets requirements to obtain Classified_qtr page for TDJ.indd TSBDE Permt Level III for Moderate Sedation. Houston, TX Sept. 2014 888-581-4448 www.SedationConsulting om LOOKING TO HIRE A TRAINED DENTAL ASSISTANT? We have dental assistants graduating every 3 months in Dallas and Houston. To hire or to host a 32-hour externship, please call the National School of Dental Assisting at 800383-3408; Web: schoolofdentalassisting-northdallas. om.

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Your Patients Trust You. Who can YOU Trust? The Professional Recovery Network (PRN) addresses personal needs involving counseling services for dentists, hygienists, dental students and hygiene students with alcohol or chemical dependency, or any other mental or emotional difficulties. We provide impaired dental professionals with the support and means to confidential recovery. If you or another dental professional are concerned about a possible impairment, call the Professional Recovery Network and start the recovery process today. If you call to get help for someone in need, your name and location will not be divulged. The Professional Recovery Network staff will ask for your name and phone numbers so we may obtain more information and let you know that something is being done.

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Texas Dental Journal l www.tda.org l August April 2014 2013

ADSRiggins. Watson,......................................................291 Brown & Associates ......................690 AJ AFTCO ....................................................................667 ADS Watson Brown & Associates................308 A.J. Riggins ............................................................661 AFTCO.............................................................309 American Academy of Facial Esthetics ...............668 Anesthesia Education and Anesthesia Education & Safety Safety....................294 Foundation ..........................................................664 Baylor College of Dentistry...........................302 DDR Dental Trust ...................................................727 Bhola,Handpiece DJ, CPA, P.C........................................291 Dental Repair Guy ..............................669 Dental Post .............................................................678 Clinton, Gary...................................................290 Dental Practice Specialists ...................................705 Dental Credentialing of Texas.......................317 Dental Spots .......................................................Insert Dental Systems Dental Practice......................................................680 Management Mentoring......291 Dental 3D Solutions...............................................667 Dental Practice Specialists............................301 Dental Trust ............................................................691 Dental Systems. ..............................................308 DJ Bhola CPA.........................................................661 FortressSpots. Insurance ................................................654 Dental ...............................................Insert Gary Clinton — PMA .............................................658 Dental Trust.....................................................313 Hanna, Mark — Attn. at Law .................................706 Hamilton, Small and Associates...................283 HighTex...................................................................661 Hindley Group ........................................................680 Hanna, Mark — Attn. at Law..........................293 JKJ Pathology........................................................668 Hindley ................................................288 Kennedy,Group. Thomas John, DDS, P.L.L.C. ................707 Medical Protective .................................................651 JKJ Pathology................................................301 North Dallas Anesthesia .......................................678 Liberty Mutual.................................................282 Ocean Dental..........................................................655 Mariner Dental Laboratory.............................280 OSHA ............................................ Inside Back Cover Paragon ..................................................................691 OSHA Review..................................................295 Patterson Dental ..........................Inside Front Cover Paragon...........................................................293 Professional Recovery Network...........................730 Professional Recovery Network...................334 Professional Solutions ..........................................662 Resolve Dental Lab ...............................................706 Professional Solutions...................................282 Shepherd, Boyd W. ................................................681 Sherri L.Henderson Henderson & Associates. ...............285 Sherri L. & Associates .......................657 Smart Training, LLC ..............................................706 Special Care Dentistry...................................288 Smile Brands/Bright Now Dental .........................662 TDA Financial Services Insurance TDA Financial Services Insurance Program. .......................................Back Cover Program ..........................................654/Back Cover TDA Member Spotlight ..........................................702 TDA Perks Program ...................Inside Front Cover TDA Perks Program ...............................................663 TDA Perks Program...................... Inside Back Cover Texas Dental Journal Classifieds.........................729 Texas Dental Journal Classifieds. Display Ads.........................332 .......................705 TEXAS Meeting ......................................................659 Texas Dental Journal Member Spotlight..............333 UTHSCSA Dental School ......................................665 Texas Health Steps.Texas ................................................289 UTHSCSA / South Pathology Lab .............661 Veatch Consulting .................................................669 UTHSCSA / South Texas Pathology Lab..............301 Waller, Joe ..............................................................681


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April 2014 TDJ  
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