OFFICIAL PUBLICATION OF THE TEXAS ACADEMY OF GENER AL DENTISTRY
DR. DONNA MILLER 2016 Texas Dentist of the Yearâ„¢!
FALL 2016, VOLUME 42, ISSUE 4
DR. HANNA LINDSKOG 2016 Texas New Dentist of the Year!
swaziland dental mission
A Group Decision
Ben Bratcher, DDS, MAGD
Dwight Peccora, DDS, FAGD
Full Mouth Implant Placement & Fixed Restor ation
Jasmine Sung, DDS, FAGD
PRESIDENT’S MESSAGE Marc Worob, DDS, FAGD
“We make a living by what we get, but we make a life by what we give.” – Winston Churchill At this year’s Texas Academy Awards, I had the honor of presenting the 18 nominees for Texas Dentist of the Year™. I asked each one for their favorite quote and the one above was the one that had the biggest impact on me. This impact was for two reasons. First, it was sent to me by Dr. James Foster of Weslaco, who unfortunately could not attend the ceremony because of his battle with cancer. I hope all of you will keep him in your thoughts and prayers as he battles this horrible disease. Second, many of us in the Texas AGD truly live by Churchill’s words. All of the nominees this year and most years I have been present at the Texas Academy Awards are not only active in organized dentistry, but have had a significant impact on their communities. It is not only the Texas Dentist of the Year™ nominees, but most Texas AGD members that I know are always looking for a way to give back. This dedication to making our professional world and the world around us a better place helps contribute to the great respect our profession receives.
Members of our organization have a unique dedication for education and learning. This past May, a group of your leadership refined our value proposition for our association; “A community of passionate general dentists partnering together to assist one another in the journey through Fellowship, Mastership and Lifelong Learning.” This passion is what our organization needs to harness in order to continue to grow and remain a vital part of organized dentistry. I need each of you to help by telling others, who aren’t members, about our organization, what it has done for you, and how it can help them improve. Joining the Texas AGD has many benefits, and now as our profession has more outside pressures from the legislature, there is not a more opportune time to tell your colleagues about us. There is strength in numbers and each one of you can make a difference. You will be proud to know that the Texas AGD has continued to lead the way nationally by being presented with its 9th consecutive Constituent of the Year Award from the National AGD, along with numerous other awards at this past summer’s national meeting in Boston. Thanks to each of you for your contribution to this success and I hope each of you will continue to give back to this organization by helping us increase our membership in the coming year. It is an honor for me to lead your organization, and I look forward to your input and participation. Please feel free to email me here with any comments or suggestions. “How wonderful it is that nobody need wait a single moment before beginning to improve the world.” – Anne Frank Marc Worob, DDS, FAGD President, Texas AGD
DISCLAIMER: The Texas AGD does not necessarily endorse opinions or statements contained in articles or editorials published in the TexasGP. The publication of advertisements in the TexasGP does not indicate endorsement for products and services. TexasGP is published quarterly by the Texas Academy of General Dentistry, 1016 La Posada Dr. Suite 200, Austin TX 78752. Address changes should be sent to the Texas AGD. TexasGP is provided as a member service to members of the Texas AGD. Nonmember subscription rates are $25.00 individual and $40.00 institutional. Canadian orders add $5.00; outside the U.S. or Canada, add $10.00. Single copy rates are $3.00 to individuals and $4.50 to institutions (orders outside the U.S. add $1.00 postage). All orders must be prepaid in U.S. dollars. Printed in U.S.A. Copyright 2016, Texas Academy of General Dentistry, Austin, TX. No portion of TexasGP may be reproduced in any form without prior written permission from the Texas AGD. The opinions expressed by TexasGP are not necessarily endorsed by the Texas AGD. The publication of an advertisement in TexasGP does not indicate endorsement for products and services. TAGD/AGD approval for continuing education courses or course sponsors will be clearly stated.
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BOARD OF DIRECTORS PRESIDENT Marc Worob, DDS, FAGD Austin IMMEDIATE PAST PRESIDENT James Bone, DDS, MAGD Kerrville PRESIDENT ELECT Jeffrey Geno, DDS, MAGD League City SECRETARY/TREASURER Randall Farmer, DDS, FAGD Houston EDITOR Andrew Lazaris, DDS, FAGD Plano
DIRECTORS Douglas Bogan, DDS, FAGD Houston Brooke Elmore, DDS, FAGD Belton Tor Gotun, DDS, MAGD Austin Anne Lyon, DDS, FAGD Austin Bryan Moore, DDS Dallas J. Dempsey Speer, DDS, FAGD Corpus Christi
TABLE OF CONTENTS Texas AGD Journey
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Advocacy Pulse - On the Frontline
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A Group Decision
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Lone Star Dental Conference Recap
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Texas Dentist of the Year™ Award Winner
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Texas New Dentist of the Year Award Winner
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Swaziland Dental Mission
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NATIONAL TRUSTEE David Tillman, DDS, MAGD Fort Worth
MasterTrack® Case Study: Full Mouth Implant Placement & Fixed Restoration
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The Secret to Effective Communication
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REGIONAL DIRECTOR Dan McCauley, DDS, FAGD Mount Pleasant
2016 Photo Contest Winners Announced
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Welcome New Members
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Calendar of Events
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COMPONENT PRESIDENTS BRAZOS VALLEY AGD Craig Scasta, DDS, FAGD Bryan
HOUSTON AGD Dath Collins, DDS, FAGD Houston
CENTRAL TEXAS AGD Ashley Strickland, DDS Buda
PANHANDLE AGD Thomas Karr, DDS, MAGD Amarillo
DALLAS AGD Jeema Dad, DDS Plano
SAN ANTONIO AGD Christina Meiners, DDS San Antonio
EL PASO AGD Patrick Mitchell, DDS, FAGD El Paso
SOUTH TEXAS AGD Benjamin Vela, DDS Corpus Christi
FORT WORTH AGD Marie Holliday, DMD Fort Worth
WEST TEXAS AGD Thomas Campagna, DMD, MAGD Midland
TEXAS ACADEMY OF GENER AL DENTISTRY STAFF EXECUTIVE DIRECTOR Francine Johannesen EDUCATION DIRECTOR Lindsey Robbins EDUCATION ASSISTANT Aleisha Stills DIRECTOR OF FINANCE Nadia Baig
COMMUNICATIONS MANAGER Leah Perkuhn COMMUNICATIONS COORDINATOR Joy Garza MEMBERSHIP SPECIALIST Megan McBride
EDITOR’S MESSAGE By Andrew Lazaris, DDS, FAGD
One of my favorite topics to discuss with dentists and dental students alike is the merits of group practice vs. traditional solo practice. When I started my practice almost 20 years ago, group practices were much less common than they are now. The practice of dentistry is evolving into different practice models. This evolution will have winners and losers. I believe group practices will definitely have a place in the foreseeable future. For only having practiced six years, Dr. Peccora really hit the nail on the head with his article on the benefits of group practice. I especially love the line about “walk-away trust.” I’m definitely stealing that when I talk about group practice. And now, a big THANK YOU to everyone who entered the photography contest! We had a lot of great submissions. Congratulations to Drs. Saskia Vaughan and Yana Kushner!
CONTACT TEXAS AGD 1016 La Posada Drive, Suite 200 Austin, Texas 78752 www.TAGD.org T
512-371-7144
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512-371-7178
The TexasGP has featured multiple dentists over the years who have “given back.” Thank you to Dr. Bratcher for sharing his experiences and thoughts on his mission to Swaziland. And now, a poetic plea to contribute to the advocacy fund. Yes, limericks are poetry. There once was an AGD dentist That didn’t like to get involved When decisions were made By those serving the state They learned that now it was too late...
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ADVOCACY PULSE – ON THE FRONTLINE By Brooke Elmore, DDS, FAGD | Texas AGD Advocacy Council Chairperson
A Strong Voice for YOU! By now, you’ve probably heard that the Texas State Board of Dental Examiners (TSBDE) is going through the Sunset Review process this year. Perhaps you’re also aware about efforts to make major changes in the regulation of anesthesia in Texas. Maybe you also know that a broad-based coalition of 25 organizations spearheaded by the Pew Foundation, continues to advocate for legislation to empower mid-level providers here. What do all of these issues have in common? All of them could have a major impact on our profession and our ability to treat patients. Without a strong voice at the Legislature, as well as at TSBDE and the Health and Human Services Commission, which oversees Medicaid providers, the unique concerns that general dentists have on these issues could be lost in the debate. That’s where Texas AGD’s Advocacy Council comes in to play. Working with the Texas AGD staff and our legislative consultant, David Mintz, Texas AGD plays an active role at both the state house and regulatory agencies. For example, even though the Sunset legislation for TSBDE will not be introduced at the Legislature until sometime in early 2017, Texas AGD has been working on this issue for more than a year. Before the initial Sunset staff recommendations were ever drafted, Texas AGD members met with the Sunset Commission staff to provide our perspective about the agency. Then once the initial staff recommendations were released last spring, the Advocacy Council analyzed the report and communicated with legislators to express concerns. Along with Dr. Dave Roberts, I testified before the commission this past June to ensure that they were aware of our opposition to proposals to change the composition of the state board and eliminate registration of dental assistants. We also advocated that any changes regarding anesthesia regulation were based on sound data to guarantee they would be meaningful and improve patient safety. Another issue that came up relatively late in the Sunset process was an effort to respond to the growing problem of opioid abuse. Among other recommendations, Senator Chuy Hinojosa offered a proposal, which the commission approved, to mandate that all practitioners who prescribe narcotics must verify those prescriptions through the Prescription Monitoring Program. All of the issues in the Sunset bill will go through the legislative process when the Texas Legislature meets January – May, 2017.
Drs. Dave Roberts and Brooke Elmore at the Sunset Commission hearing in June at the State Capitol.
Advocacy & Legislative Updates To stay current on legislative updates, check the Gatekeeper section in the Texas AGD monthly newsletter or online here!
Advocacy Council Members Chair – Brooke Elmore, DDS, FAGD Vice Chair – Shane Ricci, DDS, FAGD Advocacy Consultant – David Mintz Jennifer Bone, DDS, MAGD Donna Miller, DDS, MAGD Bryan Moore, DDS Fred Philips, DDS Susan Putthoff, DDS, FAGD Wayne Radwanski, DDS, FAGD Dave Roberts, DDS Ben Warner, DDS, FAGD Marc Worob, DDS, FAGD Kirshna Patel (student) Jon Vogel (student)
While Texas AGD will continue seeking further changes as the bill moves through the legislative process, we’ve already seen some success. Initial Sunset staff recommendations were changed bythe commission members so that a majority of the TSBDE will still be dentists, and registration of dental assistants will continue. Likewise, whether it is done as part of the Sunset legislation or through TSBDE rulemaking, we expect there to be a great deal of debate regarding new anesthesia requirements, such as requiring more stringent standards for Level 2-4 anesthesia permit holders who treat pediatric or medically complex patients. While all of these proposals are well-intentioned, we also want to make sure that whatever legislation or regulations are ultimately enacted are feasible, help advance the dental profession and protect our patients. Texas AGD will be working throughout the process to represent the unique perspective of general dentists. For me, being involved in advocating for Texas AGD is an easy decision. These issues that are coming to legislation in 2017 will no doubt affect the way you and I practice in the state of Texas. It is hugely important that we are present at the table for these discussions. Our advocacy council is working hard for you to ensure Texas AGD’s voice is heard. One way you can support our efforts is by donating to advance our advocacy efforts. Donations will be used to represent Texas AGD at the state level and will continue to make Texas AGD a strong force in Texas. Please visit the advocacy page here to make your donation today.
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A Group Decision By Dwight Peccora, DDS, FAGD
I find it hard to believe that I have been practicing for six years now since my graduation in 2010 from UT School of Dentistry at Houston. I was raised around medicine all of my life by my father and other physicians in the family, and many came to ask me time and time again, why dentistry? It was a valid question for someone like me, who at the start of dental school was more able to describe a basic technique for an appendectomy than how to take an alginate impression. My answer was basic: I wanted to serve in a specialty of medicine where I was able to control the way my business would run, and to maximize the quality of care for my patients. In such a deductible and procedure code driven industry, I wanted to make sure that I had the chance to build a business that would be patient-focused; all the while, allowing me to structure in time for my own quality of life. My method of operation for this: partnerships. The biggest question today in dentistry is what our practices will look like in 10, 20, or even 50 years from now. The one thing I have come to find that has been most successful to me: don’t do it alone! I have always found that a collaboration of ideas and perspectives reigns over the mind of ONE. This perspective aids in combating the basics of not having enough time, and the infamous “professional burnout.” I learned this in my early entrepreneurial years through building international computer programming and outsourcing firms during college, developing a dental lab during dental school, and from the acquisition and expansion of three general dentistry practices. Perhaps too many dentists are trying to do too much alone. In an ever-developing profession of technology and standards of care, partnerships provide a means to afford these standards and achieve a more balanced work life. There IS a difference between taking a vacation and trusting the care of your patients to your daily colleagues, versus having to close the office just to get a break. Even before I graduated, many dentists would tell me how expensive it is to take a vacation because you have to shut down the office. Or worse, you never take a vacation. My confusion when hearing this came from my entrepreneurial experiences in other industries where it is rare that any business relies on the shoulders of ONE key person to stay open. It is as if many of us treat our license-driven ownership requirements by the state more like an entrepreneurial shackle than an opportunity.
The truth is, we are required not only to have self-governance in our profession, but also manage the care of our patients to the best of our ability. I believe practicing to the best of my ability includes having a balanced life. We all know how hard it can be to run the practice staff, the patients, the facility, while enjoying our families, our friends, etc. Enter the benefits of collaborative group practice. My favorite thing to tell my patients is, “I am your doctor when you come here, but my partnership simply means that when I am not here, I trust those I have partnered with to care for you as best as I would.” I call this: “walk-away trust.” It takes some time to develop, but when you work together in a practice and review cases together daily, you begin to develop a similar mindset of how to care for your patients collectively - not to mention constantly finding new and better ways to care for your patients due to a collective experience and perspective. In my practices, we have gone as far as placing all our practices on cloud-based remote access so that regardless of the location of the patient, all doctors can collaborate on any case, thus providing more comprehensive care for the patient by using a team approach. In my experience, “walk-away trust” has proven crucial not only for patient care and my work-life balance, but also for my own professional development. Having the ability to walk away from the practice to better ourselves through continued education and to better our profession through supporting organized dentistry, allows us to push the profession forward. Dentists commonly discuss how the effect of business burnout has resulted in their clinical burnout. Even worse, a lack of clinical/professional development results in losing the chance of continued excitement in what we do every day because of the lack of new and inventive ideas. Being caught up in the grind of our businesses, we develop complacency and seek predictability in our daily practice. There is no such thing as predictability in medicine. Every patient is different and thus, so is every procedure. When people ask me what I believe is the key to success in our profession today, I tell them: partnerships. Partnerships not only provide better comprehensive care for our patients, but they also keep us from needing to be superhuman. In the end, we are simply friendly, neighborhood dentists!
Drs. Kevin Baethge, Brian Machart, Dwight Peccora, Randal Glenn, Jerry Baethge
“I have always found that a collaboration of ideas and perspectives reigns over the mind of ONE.”
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LONE ST R
d e n t a l c o n f e re n c e 2016 RECAP LONE STAR DENTAL CONFERENCE Chaired by Dr. Bill Nantz, this year’s conference provided attendees with numerous techniques and products to incorporate into their practice for improved patient care. Two days of CE featured speakers Dr. Alan Scott Douglas and Dr. Arthur Jeske, along with Lunch & Learn discussions, Dentalosophy, and more! Attendees connected with over 25 exhibiting companies to learn about their unique products and services.
TEXAS ACADEMY AWARDS Guests enjoyed the company of their families and fellow dentists at the Pre-Party Celebration, which honored 9 Texas New Dentist of the Year nominees. The celebration concluded with the announcement of the 2016 Texas New Dentist of the Year winner, Dr. Hanna Lindskog. Dentists from across the great state of Texas united to celebrate their journey through dentistry and to honor the Texas Dentist of the Year™ nominees at the Texas Academy Awards ceremony. The evening commenced with the presentation of the colors by The University of Texas ROTC, followed by the National Anthem sung by Dr. David Tillman, Texas AGD National Trustee. Special guest Dr. Maria Smith, AGD President, installed the 2016-2017 Texas AGD Board of Directors. Dr. Marc Worob, Texas AGD President, proudly introduced 18 Texas Dentist of the Year™ nominees, prior to the announcement of the 2016 Texas Dentist of the Year™ winner, Dr. Donna Miller.
MASTERTRACK® The MasterTrack® program educated Texas AGD members working towards Mastership in the AGD on cutting edge implant and anesthesia materials and procedures. MasterTrack attendees networked with Lone Star Dental Conference attendees and exhibitors, participated in Lunch & Learn discussions, and experienced handson continuing education.
SAVE THE DATE
September 22-23, 2017 Exclusively for Dentists!
The Renaissance Austin Hotel | Austin, TX www.TAGD.org/LSDC
LEADERSHIP AWARDS
PRESIDENTIAL AWARDS 1. Tor Gotun, DDS, MAGD 2. Kevin Gureckis, DMD, MAGD, ABGD LONE STAR DENTAL CONFERENCE CHAIR
3. Bill Nantz, DDS, MAGD PRESIDENTIAL RECOGNITION 1
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4. Brooke Elmore, DDS, FAGD 5. Saskia Vaughan, DDS, MAGD 6. Melissa Lent, DDS, FAGD ADVOCACY LEADER AWARD 7. San Antonio AGD COMPONENT TECHNOLOGY AWARD 8. South Texas AGD COMPONENT MEMBERSHIP AWARD
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9. Houston AGD CONTINUING EDUCATION AWARD 10. West TX AGD 11. Dallas AGD COMPONENT LEADER OF THE YEAR AWARD 12. Shihab Diais, DDS, MAGD COMPONENT OF THE YEAR AWARD
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13. Houston AGD
2016-2017 INSTALLATION OF TEXAS AGD OFFICERS guest Dr. Maria Smith, AGD President, proudly & BOARD OF DIRECTORS Special installed the 2016-2017 Texas AGD Board of Directors.
The Texas AGD officers include: President Marc Worob, DDS, FAGD, President-Elect Jeffrey Geno, DDS, MAGD, Secretary/Treasurer Randall Farmer, DDS, FAGD, Immediate Past President James Bone, DDS, MAGD, Editor Andrew Lazaris, DDS, FAGD. The directors include: Douglas Bogan, DDS, FAGD, Brooke Elmore, DDS FAGD, Tor Gotun, DDS, MAGD, Anne Lyon, DDS, FAGD, Bryan Moore, DDS, J. Dempsey Speer, DDS, FAGD, Regional Director Dan McCauley, DDS, FAGD, National Trustee David Tillman, DDS, MAGD, and Executive Director Francine Johannesen.
Texas A
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Dr. Donna Miller
TEXAS DENTIST OF THE YEAR ™
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“‘Wow!’ was the first word I uttered that night, and I am still saying Wow. I am most humbled, honored and filled with gratitude to be named Texas Dentist of the Year™. This takes on even more significance as I studied all the names on the trophy of folks that have been named before me. So many of these are my mentors, dentists I have looked up to for examples, guidance, and friendships. Being included and named with this group of great servant leaders in dentistry and life definitely accentuates the bar of excellence that I strive to reach on a daily basis. Knowing many of my fellow nominees, and hearing the accomplishments of all of the nominees instilled even greater humility. Serving in the Texas Academy of General Dentistry has caused me to focus on the quality of dental care that I give daily, has taught me better techniques and procedures, and serving as an advocate for this profession has created a fervor for excellence. The congratulations, support and words of acknowledgement from my colleagues, my dental team, my patients, along with family, friends and people I do not even know has been overwhelming. Receiving this award is one of the most thrilling, yet humbling events of my lifetime. Being named Texas Dentist of the Year™ has multiplied my desire for excellence tenfold.”
- Donna Miller, DDS, MAGD
“Thank you to the Texas Academy of General Dentistry. Gleefully, I will give my very best to fulfill this honor that has been bestowed upon me!” 10 | Fall 2016
Academy
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Dr. Hanna Lindskog
NEW DENTIST OF THE YEAR
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“As I stood at the Texas Academy Awards Pre-Party and listened to all of the accomplishments of the nominees for Texas New Dentist of the Year, I was in awe and inspired by all of my colleagues. When my name was called out, and I was awarded the 2016 Texas New Dentist of the Year Award, all I could think was that every single nominee was so deserving of this award. I am so honored to have been chosen from among this group for this award. I couldn’t have done all of this without the support of my family, mentors, friends and support staff at the Texas AGD. The Texas Academy of General Dentistry has become family to me, and I cannot express enough what it means to me to represent this group. I am committed to supporting our profession and look forward to continuing to serve within this organization.”
VISION FOR THE FUTURE OF DENTISTRY The manner in which dentists choose to implement and utilize the vast amount of emerging research and technology will determine the future of dentistry. Current research continues to tie medicine and dentistry through sleep medicine and through the correlation of cardiovascular disease, diabetes, autoimmune disorders and periodontal disease. Research has also given us new materials, improved current procedures and verified existing knowledge. Dentists hold a responsibility to continue our education throughout our career, share this knowledge with our colleagues and patients and refer them to appropriate medical providers when appropriate. As dentists, we have the power to advocate for our profession. Organized dentistry not only provides dentists with an avenue to obtain essential continuing education, but also allows for dentists to serve the community and play a role in legislation affecting the profession. Dentists that are united through organized dentistry will be able to continue to provide a high quality of comprehensive patient care, utilizing the most current technology and knowledge, as well as serving the community and their profession. - Hanna Lindskog, DDS, FAGD
“I am committed to supporting our profession and look forward to continuing to serve within this organization.” Fall 2016 | 11
Swaziland
Dental Mission by Ben Bratcher, DDS, MAGD
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a king who boasts of having 14 wives while his country has the sad distinction of over 50% of its populations suffering from HIV/ AIDS. In the recent Olympics, two athletes represented Swaziland in Rio.
One of the things I love about dentistry is that it affords us opportunities. We have opportunities to earn an above average wage. We can provide for our families in ways that many of us did not have growing up. We can be influential in our community and in the dental community. And, we can give back to those less fortunate. Organized and individual dentistry has a long history of compassionate care. There are literally hundreds of opportunities to serve the underserved in our local communities, statewide, nationally and worldwide. Our desire to “give back” has spawned multiple organizations to help us with our causes. Some of these are religious based, some secular and some are educational/profit based, but the humanitarian spirit lives in all. This is a short story of a religious based mission effort that I have been blessed to be a part of for over 15 years now. Over 15 years ago, I felt a calling to serve in remote areas overseas. A lady invited me to be part of a trip to Southern Africa to work with the people of a small country called Swaziland. I was so fortunate to answer that calling then and continue to be blessed by it today. Swaziland is a very small country in Southern Africa bordered on the South and West by South Africa and on the East by Mozambique. It is roughly the size of New Jersey and is home to just over 1 million people. It is ruled by
Our ministry actually involves a small team of short-term missionaries who provide a range of services. In addition to the dental care we will talk more about shortly, we provided spiritual guidance in the form of men’s and women’s ministries, children’s ministries, revivals, preaching at local churches, clothes, and food for the children and BGR buckets, Baptist Global Relief. These buckets are packed with supplies that people can use to care for those in their homesteads, who are suffering from AIDS or other related illnesses. The dental services are provided in makeshift clinics set up in tents, small buildings, church buildings and sometimes, under a tree. We are obviously very limited in what we can provide, so our services consist exclusively of preventive training and pain relief in the form of extractions and minor surgical care. On this past trip, we were able to provide preventive care to over 250 people, mostly children, and saw about 150 patients for extractions. We try to do as much as we can for each person while also doing our best to see as many individuals as possible. While the dental team is providing care, other team members are sharing the gospel and ministering to the local people. The details of how all of this is done are difficult to describe in a short format such as this but hopefully, the photos will explain some of it. A summary includes carrying most of our supplies from the U.S. including instruments, anesthesia, cotton products, and ancillary supplies
like sutures and blades. Some supplies have to be purchased there because of the limitations in carrying liquids on the plane. Sterilization and high-level disinfection are achieved using glutaraldehyde and chlorhexidine. During the day, the instruments are scrubbed and soaked for a minimum of 20 minutes. Each night, the instruments are soaked through the night to reach sterilization levels. As many disposable supplies are used as possible. The Texas AGD was very gracious to supply several hundred disposable mirrors that we put to great use. Sterile water and chlorhexidine mouth rinse are purchased from a pharmacy in Johannesburg, South Africa when we arrive. With no power most of the time, we use flashlights for illumination and all extractions are carried out with hand instruments only. Needless to say, there are plenty of opportunities for learning in an environment like this. As we return from Swaziland, we pass through Kruger National Park to see some of Africa’s wildlife in its natural state. This is a truly miraculous vision and a small reward for our hard work and time in ministry. We were blessed on this last trip to have seen each of the “Big 5” – Lion, Leopard, Elephant, Buffalo, and Rhino among countless other spectacular creatures. I will conclude by saying I have many, many colleagues who provide humanitarian relief in numerous ways and venues. The Texas Mission of Mercy, The Christian Medical Dental Association, Doctors Without Borders, Mercy Ships, among countless others, provide opportunities for all of us to “give back.” We all serve according to our gifts and callings, and I have been blessed to have been called to serve the wonderful people of the struggling country of Swaziland.
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CASE STUDY
FULL MOUTH IMPLANT PLACEMENT & FIXED RESTOR ATION WITH BONE MANIPULATION & GR AFTING Jasmine Sung, DDS, FAGD
SMILE MAKEOVER Patient: Ann Age: 58 Occupation: Accountant Medical history: anxiety, depression
Abstract: Treatment planning for implant dentistry in a fully edentulous mouth with poor quantity and quality of bone can be intimidating, but using Carl Misch’s treatment planning sequence, Hilt Tatum’s philosophy NIRISAB (Natural Implant Restoration in Stable Alveolar Bone) and his bone manipulation and grafting techniques help to make the case more predictable. Many dentists when faced with inadequate bone will place an all-on-four prosthesis with implants in the pterygoid or zygomatic bone, resulting in distal cantilevers, angled implants, or shorter implants. Though this can often be a successful solution, the concern is whether this can support a long-term fixed prosthesis. The primary cause of complication in implants is related to biomechanical stress. Using both Tatum’s and Misch’s principles and techniques, I was able to provide a long-term fixed restoration to improve her speech, function and esthetics. Introduction: The patient presented with a skeletal Class II, non-restorable decay, and Class III mobility maxillary anteriors. She suffered domestic sexual abuse and assault, resulting in her front teeth being injured and left without proper care. When her anteriors were deemed non-restorable, she came to me for an evaluation on how to have a fixed long-term solution to restore function and esthetics. Case Report: Originally, the plan was to save her lower anteriors, but during treatment it was evident that this would become a fully edentulous case. She was treated in the following phases:
PHASE 1 Extracted hopeless teeth and temporized in upper full denture.
Fig. 1 Frontal of teeth
Fig. 2 Occlusal of maxillary arch
Fig. 3 Occlusal of mandibular arch
Fig. 4 Frontal of face. Patient refused to smile.
Fig. 5 Profile of face
Fig. 6 Frontal of smile
Fig. 7 Occlusal of maxillary after extractions
Fig. 8 Frontal of mouth after extractions
Fig. 9 CBCT of maxillary occlusal
Fig. 10 CBCT of frontal
PHASE 2 Maxillary anterior bone was originally ~2 mm, so bone was bisected with a 15 scalpel and then expanded with osteotomes to ~6 mm to place D-plateau implants. Fig. 11 Sagittal CBCT of tooth #8. B-P width = 2.05 mm, height = 13 mm
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Fig. 12 15 scalpel bisecting bone
Fig. 13 D-plateau implant placed in site #9 using Tatum osteotomes to expand bone
Fig. 14 D-plateau implants placed in sites #6, 8, 9, 11
PHASE 3 Bilateral sinus grafts, and on lower right a remote incision tunnel onlay graft using cancellous bone mixed with hydroxyapatite.
Fig. 15 Lateral window access to sinus with Schneiderian membrane reflected on upper right quadrant.
Fig. 16 Collatape placed in sinus.
Fig. 17 Irradiated cancellous bone mixed with hydroxyapatite graft
Fig. 18 4-0 vicryl sutures used to close flap
PHASE 4
Fig. 19 Pre-op occlusal of mandibular Fig. 20 Remote incision tunnel arch prior to grafting. Straight wire onlay graft on lower right orthodontics was attempted, but mandibular teeth ultimately had to be extracted. Note how thin the bone is on the posterior quadrants.
PHASE 5
Extraction #22, 23, 24, 25, 26, 27 and immediate implants placed on #22, 23, 26 and 27. Implant placement on #3, 4, 5, 12, 13, 14, 19, 20, 29, 30 using bone expansion.
Facebow transfer used to create provisional bridges, which were worn for 3 months to check occlusion, speech and esthetics.
Fig. 21 Occlusal of maxillary arch
Fig. 22 Occlusal of mandibular arch
PHASE 6 Seated final PFM prosthesis and delivered occlusal guard.
Fig. 23 Full face smile
Fig. 24 Profile of smile
Fig. 25 Profile of face. Good lip support.
Fig. 26 Frontal smile
Fig. 27 Frontal teeth
MATERIALS
REFERENCES
Tatum D plateau implant | Tatum T tapered implant | Rocky Mountain Tissue Bank irradiated cancellous bone | Impladent HA Osteogen | Porcelain fused to base metal final restoration | Jet acrylic temporary restoration | Prexion CBCT
Misch, Carl E. Contemporary Implant Dentistry, Third Edition. Mosby Elsevier, 2008. Print Misch CE., Consideration of Biomechanical Stress in Treatment with Dental Implants, Dentistry Today 25 (5) 80-85, May 2006. Tatumsurgical.com
DISCUSSION & CONCLUSION The patient was thrilled with the results and remarked that the first thing she ate with her new teeth was a salad. For decades, most of her food was soft or pureed, and she felt it refreshing to eat something as basic as lettuce. My goal in dentistry is to care for my patients to the best of my ability and to treat them with respect and compassion. Using Tatum’s NIRISAB philosophy, I believe that I can restore and maintain my patients in natural contour, comfort, function, esthetics and health. I feel that there is a lot of commercial influence on the field of implant dentistry teaching dentists to take away natural bone to fit their prosthesis. Carl Misch developed a treatment plan sequence that I try to use for every patient consisting of: 1) Prosthesis design, 2) Patient force factors, 3) Bone density in the edentulous sites, 4) Key implant positions, 5) Implant number, 6) Implant size, 7) Available bone in the edentulous sites and 8) Implant design. This patient had very poor quality bone and in most areas low quantity, but using Tatum’s bone expansion, lateral window access sinus grafting, and remote incision tunnel onlay grafting techniques, I was able to restore the quantity and improve quality of bone to utilize Misch’s sequence to create as biomechanically correct of a prosthesis possible.
Tatum Institute lectures, Birmingham, UK.
About Dr. Jasmine Sung Dr. Jasmine Sung received her undergraduate degree from Wellesley College in Massachusetts and her dental degree from Baylor College of Dentistry. She completed her 10-month implant training with Dr. Hilt Tatum at the Tatum Institute in Birmingham, UK, and she continues to learn from him and other mentors at the Tatum Institutes in Atlanta and Normandy, France. She has received her Associate Fellow in the American Academy of Implant Dentistry (AAID) and her Fellow and Master in the International Congress of Oral Implantologists (ICOI). She plans to receive her Mastership in the AGD in 2017 and is actively working to achieve Diplomate status in both the AAID and ICOI.
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The Secret to Effectiv By Lois Banta
“I’m sorry. We have not received your claim.” “Why did I get a statement? I have already paid your office my co-payment!” Ah...the results of miscommunication! There are few things more frustrating for the dental practice than the patient or insurance company who misunderstands what we expect from them, or the patient who doesn’t understand the practices current payment guidelines. An important, if not the most vital aspect of dentistry in today’s environment is not what we say to patients and insurance companies, but how we say it to them. How many times have you called the insurance company to track a past due claim only to be told you have to re-submit it? (Believe me, I can hear your silent screams now.) There is a correct way to conduct your phone call to the insurance companies and achieve optimal results the first time you speak with them. One of the most effective tools in communicating with insurance companies and receiving prompt
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payments isn’t necessarily the content of your claim, but how you converse with the insurance Customer Service Representative (CSR). You will catch more flies with honey by making a friend in the insurance company... this requires preparedness while pleading your case to get the immediate results you’re expecting. Call the insurance company with this conversation in mind: “Hello. This is Lois from Dr. Smith’s office. I’m calling to check the status on an outstanding dental claim.” Never say past due claim. It tends to place the CSR on the defensive. A good rule of thumb is to always note the date, the CSR’s full name, and any pertinent information discussed in the conversation. It is my experience that a few insurance companies train their staff to respond to your first phone call by telling you they have not received your claim. In this event, I suggest asking the CSR to put you on hold and check their
pending or in-process claims. This allows the person you’re speaking with to hopefully come back and tell you, “Oh, there it is! I don’t know why this wasn’t processed yet.” If they still insist they have not received the claim, ask for their FAX number and resubmit the claim by FAX, not “snail mail,” or electronic claims, if that is how it was originally sent. The communication between your practice and your patients can be just as frustrating if you assume they know your financial policies - put it in writing. Always, and with no exceptions, explain all treatment recommendations to your patients before their dental treatment is performed. With so many types of treatment consultations, there are numerous, effective ways of discussing these financial arrangements with patients.
ve Communication 1) If the patient is in your practice for an emergency and there is time to do the final restoration that day, the Financial Coordinator should meet with the patient to answer any questions the patient may have regarding fees, their insurance and estimated amount due. This allows the patient to make an informed decision. It is imperative for the doctor and clinical team to leave the treatment room to allow for privacy and for the patient to be seated in a nonvulnerable position…seated upright if in the treatment room or in the consultation room. Discussing financial arrangements early allows for proper communication to take place regarding the patient’s financial responsibility. 2) If the patient has a continuing care appointment with the hygienist, and dental treatment was recommended that is not too involved, the Financial Coordinator can make financial arrangements in the consultation room or at the front desk (if it is a private enough area). All financial arrangements should be made before the patient comes in for the next treatment appointment to avoid any unexpected, negative surprises. 3) If extensive treatment is needed, a formal, private consultation with the patient and the financially responsible party (if different from the patient) should be provided. In all cases, a written plan for treatment and estimate of financial responsibility should be available to every patient. Your patients have the right to know what they are agreeing to. It’s called truth in lending.
The importance of effective communication also becomes a priority for patients paying their “estimated portion” after their insurance payment is estimated and at the conclusion of their dental appointment. Discuss the potential amount due before they receive a surprising amount due on their statement. To avoid any repercussions from receiving a statement after insurance pays and the patient has already paid their “estimated portion,” I suggest telling the patient, “If insurance pays less than we estimated, we will send you a final statement and it will be highlighted at the bottom of your statement with the phrase we have received final payment from your insurance.” This absolutely has the potential to prevent an angry phone call from the patient who has previously made an in-office payment. Give your patients the potential “bad news” before they receive a final statement, and you have diffused a potential negative situation. When an amendment is necessary in your practice financial policy, there is an effective communication technique that I recommend. I find this the most difficult transition for the patients if they are accustomed to “making payments.” First, you should never have to assume the role as “the bank” for your patients. Time and time again I see this as the dental practice’s most significant problem. In order to change the rules effectively you need to convey your practice as being excited about the change.
Your conversation should be: “Mr. Jones, today’s visit was $700.00. Including your previous balance of $300 and with the estimated insurance payment of $350, the portion is $650. How would you like to handle payment today…cash, check, or bank card?” The patient typically responds, “Just send me a statement like you usually do.” This is where the magic of your conversation must happen. Reply, “Actually, we are so excited. Our payment guidelines have changed and we are now prepared to handle your payment in-office today. So…will that be cash, check, or bank card?” If the patient still objects, give them a courtesy statement with a self-addressed stamped envelope and instruct them to send the estimated payment within the next five days. Let them know you will follow-up with a phone call if, for any reason, a payment is not received in five days. By far the most important aspect of effective communication is to remember the “art.” Always speak to your patients and/or insurance companies the way you would want them to speak to you and remember this Golden Rule … “Do unto others as you would have them do unto you!”
Lois Banta is CEO, President and Founder of Banta Consulting, Inc., a company that specializes in all aspects of dental practice management. Lois has almost 40 years of dental experience. Lois is also the owner of The Speaking Consulting Network, the industry’s number one learning lab to build or enhance a successful speaking, consulting and writing business.
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PHOTO 2016 CONTEST
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st
Stars and Lightning Enchanted Rock, Texas Saskia Vaughan, DDS, MAGD
This one stood out instantly. Seeing both a starry sky and a bolt of lightning in the same shot is breathtaking. The lightning storm gives the illusion that the sun is also rising adding to the mystery of the image.
2
Nature’s Blanket
nd Pacific Coast
Yana Kushner, DDS (Top)
I love this photo because it’s more than just a landscape – it’s a feeling. It is moodiness, melancholy and passion. I love that the photographer chose to make it black and white further adding to the dramatic feel.
3
One is the Loneliest Number
rd California
Yana Kushner, DDS (Bottom)
The thing I like about this image is the documentary feel behind it. It’s an intimate moment where we get to share a behind the scenes look into the private life of this photographer.
Thank you to Jessica Attie for judging this year’s photo contest! Jessica is an editorial and commercial photographer living and working in Austin, Texas with her husband and sweet daughter. Jessica graduated in photography at the top of her class at St. Edward’s University where she learned how to be an artist from compassionate and beautiful teachers. She was awarded a summer position at the Santa Fe Photography Workshops where she had the privilege of learning from some of the top photographers in the country. From there, Jessica taught photography to at-risk teens, developed a wedding photography business with a dear friend, worked on local editorial assignments and then landed a staff photography position with the marketing department at St. Edward’s University. She’s currently a full time freelance photographer shooting food and portraits around Central Texas.
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Welcome New Members May 15, 2016 – September 15, 2016
The members of the Texas Academy of General Dentistry make up a community of over 2,700 general dentists. We are proud to be the largest constituent of the Academy of General Dentistry (AGD) and we continuously serve our members through high quality continuing education, advocating for general dentists, and overall helping general dentists succeed. We would like to recognize and welcome the members below who have recently joined the Texas AGD. These members joined between May 15th, 2016 and September 15, 2016. Centr al Texas AGD Mike Asay, DDS Round Rock
Jeffrey Colin, DDS Pflugerville
Megan Gimdt, DDS Round Rock
Courtney Grosskopf, DDS Round Rock
Brian Wong, DDS
Michael Guzman, DDS
Frisco
The Woodlands
May Yeap, DDS
Dana Hailat, DMD
Richardson
Houston
East Texas AGD Steven Puffer, DMD Nacogdoches
Blake Mulgrew, DMD Austin
Ryan Angwin, DDS
Austin
Richard Otis (Affiliate) Austin
Bruce Roach, DDS
Houston
Anthony Osei, DDS Houston
Andrew Pham, DDS Fort Worth AGD
William Myers Jr., DDS
Chelsea Martin, DDS
Fort Worth
Jihyun Lee, DMD
Spring
Charles Simmons, DDS Spring
Azle
Rio Gr ande Valley AGD
Steven Peterson, DMD
Francesca Barbin, DDS
Denton
McAllen
Austin
Dallas AGD
Heart of Texas AGD
Kim Cao, DDS
Breya Pazmino, DDS
Dallas
Temple
River District AGD Colby Day, DDS New Braunfels
Sridhar Chinta, DDS Irving
Thanh Hong, DMD
Houston AGD
Frisco
Jaafar Achkar, DDS
Glenn Krieger, DDS Lewisville
Lily Morgan, DDS Richardson
Elianne Ortiz, DDS Dallas
Hamid Jay Shafi, DDS Dallas
Allen Williams, DDS Irving
Michael Wing, DDS Dallas
Pearland
Kauser Bari, DDS Rosenburg
Nedith Casquete, DDS
San Antonio AGD Robert Graham, DDS San Antonio
Kyu Mee Yo, DMD San Antonio
Pearland
West Texas AGD
Lauren David, DDS
Jay Fandell, DDS
Liberty
San Angelo
Joel Diaz-Arana, DMD
Jessica Lewis, DDS
Houston
Lubbock
Andrea Fernandes, DMD Houston
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TEXAS ACADEMY OF GENER AL DENTISTRY
Calendar of Events NOVEMBER 2016 Wednesday, November 2 San Antonio AGD FellowTrack Occlusion Part 2 w/ Dr. Perry Wednesday, November 2 Dallas AGD FellowTrack Dental Technology Wednesday, November 2 Houston AGD FellowTrack Discussion Panel Wednesday, November 2 Houston AGD New Dentist Study Club Social Media w/ Dr. Josh Austin Thursday, November 3 Dallas AGD Wine & CE Series #4 Periodontics for the General Practitioner w/ Dr. Aline Speer Thursday, November 10 Dallas AGD New Dentist Study Club Complex Treatment Planning w/ Dr. Rowan Buskin
Thursday, November 10 San Antonio AGD Back to Basics. Session #2 Interceptive Orthodontics w/ Dr. Keith Wilkerson Thursday, November 10 CenTex AGD Social Friday, November 11 Panhandle AGD Restoring Root Caries & Prosthodontic Pearls Clinical Implications of Common Drugs & Dental Management w/ Dr. Randy Huffines Wednesday, November 16 San Antonio AGD New Dentist Study Club Case Presentations Wednesday, November 16 Fort Worth AGD Town Hall
DECEMBER 2016 Thursday, December 1 Dallas AGD FellowTrack Implants
Friday, December 2 Texas AGD Board Meeting Austin, TX Tuesday, December 6 San Antonio AGD FellowTrack What Labs Want From Us w/ Luis Rubio Wednesday, December 7 Houston AGD New Dentist Study Club Special Patient Care w/ Dr. David Fray Thursday, December 8 South TX AGD Installation & Christmas Social
For more info or to register call the Texas AGD office at 512-371-7144 or visit tagd.org/events
thank you to our statewide education partners
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