2013 WMDDS Spring Bulletin

SPRING ISSUE 2013 VOL. 45, NO. 3

Bulletin

T h e

L a b o r a t o r y

N e t w o r k

is PROUD TO sPONsOR

Predictable Procedures From A To Z PReSenTeD By: Dr. Chris ramsey FRIDAy, SePTemBeR 13, 2013 | 6 Ce CReDITS

Course overview: Knowledge of dental materials and the most advanced products is necessary to maximize the success of your practice. This presentation is appropriate for dentists and their clinical staff members.

• IPS e.max®—whats the latest and greatest?

• Full-contour zirconia is here to stay!

• Understanding the Cadent™ iTero™ and the new True Definition Scanner from 3m™ and the benefits of both systems.

• Incorporating the use of these scanners in implant dentistry.

• Highlighting the latest ceramic systems, including the pros and cons of each.

• Understanding the latest cementation options and their indications.

• Addressing the latest adhesives—what is working and what is not.

• Restorative and biological guidelines for implant dentistry.

Dr. Christopher ramsey, DmD Christopher D. Ramsey was raised and currently practices in Jupiter, Florida. His practice focuses on comprehensive esthetic and restorative dentistry. Dr. Ramsey received his dental degree from Temple University school of Dentistry in Philadelphia, Pennsylvania in 1999.

Dr. Ramsey is an accredited member of the American Academy of Cosmetic Dentistry and is also an Alumnus of the Pankey Institute in Key Biscayne, Florida. He is on the editorial review boards for the AACD Journal of Cosmetic Dentistry and the Journal of Implant and Restorative Dentistry. He has published numerous articles on customer service related topics, adhesive technology and cosmetic dentistry in several publications such as the Journal of Implant and Restorative Dentistry, Journal of Esthetic and Restorative Dentistry, PPAD, Dentistry Today, Contemporary Esthetics, Signature, and the Dental Products Report. Dr. Ramsey is a product consultant for The Dental Advisor, and to numerous dental manufacturers, garnering greater insight into the newest materials and techniques. He also has the unique opportunity to lecture both nationally and internationally on cosmetic dentistry and the elements needed to create successful, esthetic-based practices.

Dr. Ramsey takes over 200 hours of continuing education a year to stay on the cutting edge of cosmetic dentistry, which is a rapidly changing profession. He is the past President of The Florida Academy of Cosmetic Dentistry.

DSG Americus Dental Lab is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement. The current term of approval extends from 6/1/12 to 5/31/14.

DATES/LOCATIONS: Friday, September 13, 2013 Frederick Meijer Gardens and Sculpture Park 1000 East Beltline Ave NE Grand Rapids Charter Township, MI 49525 REGISTRATION & CONTINENTAL BREAKFAST: 8:00 a.m. – 9:00 a.m.

PROGRAM: 9:00 a.m. – 3:30 p.m.

LUNCHEON: 12 p.m. – 1 p.m.

HOW TO REGISTER: Online – register at dentalservices.net/davisramsey By phone – contact Sue Isenga at 616-261-9191 By email – sisenga@dentalservices.net PAYMENT: Payments can be made in advance or in person by check or credit card ONLY. If mailing a check, please include your first and last name, name of your practice, contact information, and the names of attendees with your check. Make checks payable to DSG Davis Laboratory and mail to: DSG Davis Dental Laboratory ATTN: Sue Isenga 5830 Crossroads Commerce Pkwy Wyoming, MI 49519 COST: $225 per doctor | $125 per staff member RSVP by September 6, 2013.

RegisteR by July 1st and Receive $25 off youR tuition!

Registration fees include continental breakfast, luncheon and handout materials and an open pass to the Frederick Meijer Gardens until 5:00 pm on the day of the seminar.

TERMS AND CONDITIONS: • Registrations are not considered final until payment is received in full • DSG Davis Laboratory reserves the right to cancel seminars that do not meet minimum enrollment expectations • The registration fee will be refunded in full if DSG Davis Laboratory cancels the seminar • Attendee will receive 100% refund of the registration fee if attendee cancels four weeks or more prior to the seminar

T h e

L a b o r a t o r y

N e t w o r k

DSG Davis Dental Laboratory 5830 Crossroads Commerce Pkwy Wyoming, MI 49519

Contents ­Editor

Dr. Jeff Smith

Associate Editors

Dr. Seth Vruggink Dr. Derek Draft Dr. Aric Smith Dr. Brian Licari

President’s Message...................................................................................................... 2 Editor’s Thoughts......................................................................................................... 3

Advertising Editor Elaine Fleming

Executive Secretary WMDDS

511-F Waters Building

Grand Rapids, MI 49503

(616) 234-5605

efwmdds@aol.com

Trustee Report.............................................................................................................. 4

West Michigan District Dental Society Executive Board 2012-2013 President Dr. Tyler Wolf President-Elect Dr. Margaret Gingrich Vice President Dr. Samuel Bander Secretary-Treasurer Dr. Kathleen Ellsworth Editor Dr. Jeff Smith Immediate Past Dr. Larissa Bishop President Directors Dr. Steve Conlon

Dr. Leonard Bartoszewicz

Dr. Brian Mulder Area Representatives Kent County Dr. Michael Palaszek Ionia-Montcalm Dr. John O’Donald County Mecosta County Dr. Erick Perroud Ottawa County Dr. Meredith Smedley

Practice Management...................................................................................................20

MDA IV District Trustees

WMDDS Tooth Time event, February 2013.

Photo courtesy of Dr. David Huyser, chairperson of the Tooth Time event.

Dr. Brian Cilla Dr. Colette Smiley

Big Rapids Dental Study Club Officers President Dr. Erick Perroud Vice President Dr. Christa Stern Secretary Dr. Christa Stern Treasurer Dr. Erick Perroud

A Brief Primer and Literature Review on Crown Surgery......................................... 8 Technically Speaking....................................................................................................16

Classified Ads................................................................................................................22 Advertiser Index............................................................................................................23 WMDDS Summer CE Program...................................................................................24

About the Cover

Holland-Zeeland Dental Society Officers President Dr. Meredith Smedley Treasurer Dr. Robert Ankerman Secretary Immediate Past President Ionia-Montcalm Dental Study Club Officers President Treasurer Dr. Kirkwood Faber Kent County Dental Society Officers President Dr. Norman Wilhelmsen Vice President Dr. Michael Palaszek Secretary Dr. Kathryn Swan Treasurer Dr. James Papp West Michigan Dental Foundation Officers President Dr. John Marshall Vice President Mrs. Wendy Mc Ginnis Secretary Mrs. Carol Klein Treasurer Mr. Joe Van Laan The Bulletin of the West Michigan Dental Society is published six times a year (the winter issue, spring issue, summer issue, directory issue, fall issue, and holiday issue). The opinions expressed in The Bulletin are not necessarily the opinions of the West Michigan District Dental Society.

Contributions to The Bulletin are welcome and should be addressed to The Bulletin Editor, 3050 Ivanrest SW, Suite B, Grandville, MI 49418.

Requests for purchase of advertising space should be directed to the Advertising Editor, Elaine Fleming, (616) 234-5605. The deadline is the 1st of the month prior to publication. © 2012-2013 West Michigan District Dental Society Bulletin

Mission Statement The Bulletin is the newsletter of the WMDDS and its mission is to inform the membership of upcoming and recent events, state & local issues related to dentistry, and as a forum for its officers, representatives, and members to discuss appropriate topics of interest to the membership.

Communication & Advertising Policy The Bulletin will publish submitted articles from members and others that relate to the practice of dentistry, small business, social, or political issues affecting dentists, or other subjects of interest to the membership. All published items are subject to space restrictions and the community standards of the WMDDS. The editors reserve the right to reject any article or advertisement deemed ­inappropriate and to edit submissions as they see fit.

Submission & Publication Policy: Articles and advertisements must be submitted no later than the 1st of the month preceding p ­ ublication date. The Bulletin has six publications: the winter issue, spring issue, summer issue, directory issue, fall issue, holiday issue. Direct submissions or c­ orrespondences to:

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

Dr. Jeffrey S. Smith • 3050 Ivanrest SW, Suite B • Grandville, MI 49418 Phone: 616.531.1554 FAX 616.531.6947 • Email: jssmith@comcast.net Include “Newsletter” in the subject line

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PRESIDENT’S MESSAGE

What is Needed Expected of You

By Tyler A. Wolf, DDS, WMDDS President

S

ince the plea for you to help people based on the human condition has fallen on deaf ears, I will take another tack…

You do know that there are way too many people in this very community that are without the means to have dental care.… Right? Please tell me you are aware of this.

Wouldn’t you rather choose to volunteer your time rather than be made to? Or what about having someone trained to do your job for you if you will continue to fail to step up to the plate? I would think that you would have seen the writing on the wall by now. If you don’t know what the term “access to care” means to our profession, than you need to pull your head out of that dark space and open your eyes. Have you not witnessed already what is going on politically with health care on a national level? Do you understand that dentistry is a logical eventuality to be included with this downhill snowball?

Do you not understand that the very institutions that trained you are now looking to instruct people that will be able to do many of the things that you do – but more cheaply, and with much less education?

I truly hope that this is not the first time that you are thinking about these things.

I know that there are many of you out there who are already doing a lot. Whether it is within your own practice or taking advantage of opportunities within your community to give back, it is all an accomplishment that you should be proud of. Unfortunately, you add up to a very small percentage of practicing dentists in this area. You are not to whom I am speaking.

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If you don’t know whether I am addressing you right now or not, then I probably am. You need to start giving of your time, and start making more of a difference.

At the risk of sounding dramatic and cliché, strong powers are at work to forge ahead with a “solution” to this access problem – with or without our input as dental professionals.

This is being backed and funded by some entities with very large and deep pockets. The research, testing, and training are occurring as I write this; at both Schools of Dentistry in Michigan.

Hopefully you are now asking, “What can I do?”

Here’s a list which is completely off the top of my head, in no particular order, and in no way all inclusive: • Mel Trotter Ministries • Ottawa County Health Department – Miles of Smiles Dental Mobile Unit • Adult Dental Services Program • Donated Dental Services • MOM (Mission of Mercy) Project We all have busy jobs, schedules, families, etc. You know that you have no real reasons not to volunteer… only excuses.

Thanks for reading. It has been my privilege to serve as your WMDDS President this year. Any questions, comments or concerns, please feel free as always: tawdds@comcast.net or 457-4600.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

EDITOR’S THOUGHTS

Life (and the Practice of Dentistry) Isn’t Getting Any Simpler

By Dr. Jeff Smith, WMDDS Editor

I

f memory still serves me correctly, it seems that back in the dark ages after graduating from dental school and opening up an office, most of my patients were reasonably healthy and the amount of medications that they took regularly could be kept on a scrap of paper the size of a small grocery list. Fast forward almost three decades, my patients and I have grown older together, and for many, that short list has become a thin book. As our patients routinely take more and more prescription and non-prescription medications, we have to be more mindful of how some of these drugs can affect many of the procedures that we perform daily.

While the scope of all of the possible interactions between dentistry and the drugs that our patients use (and may abuse) is the subject of a textbook, this short article is meant to focus on some of the more common “blood thinners” that we see on our patient’s health histories. I’m sure that almost everyone reading this has at some time successfully done what appeared to be a routine extraction, or some other simple surgical procedure, only to be surprised by how difficult it was, or how long it took to get adequate hemostasis. In some of these cases, the patient may not have been taking any known thinner at all. As our patients mature, some are prescribed anti-clotting agents in conjunction with histories of stroke, heart attacks, atrial fibrillation, or prosthetic heart valves.

Many also receive these medications after the placement of vascular stents or artificial joints.

While we learned the intrinsic and extrinsic clotting cascades at one time, the bottom line is that there is no single test that we can order or request be ordered for our patients that covers all of the possible hemostasis complications that can occur after dental surgical procedures. Some of the more

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

common tests measure antiplatelet activity, which are separate and unrelated to tests which measure the intrinsic and extrinsic coagulation pathways.

Aspirin, NSAIDS, Plavix (clopidogrel), Ticlid (ticlopidine), and Effient (prasugrel) all affect platelet function. Tests to review would include: the Platelet Function Assay and Platelet Count. Verify Now Aspirin is a new test that documents the presence or absence of effective aspirin inhibition of platelet activity. The Verify Now P2Y12 test measures platelet inhibition in patients using Plavix or related drugs.

Many of our patients are taking Coumadin (warfarin).

This drug affects vitamin K dependent clotting factors. The Prothrombin Time (PT), and International Normalized Ratio (INR) tests measure the extrinsic coagulation pathway, and are appropriate for this medication.

Pradaxa (dabigatran) is a newer oral medication which inhibits thrombin formation. It was introduced because it eliminates the need for continuous PT/INR monitoring which is usually necessary for patients taking Coumadin (warfarin). The Activated Partial Thromboplastin Time (aPTT) or Thrombin Time (TT) tests are used to measure its anticlotting effect. PT/INR tests will not measure the effect of Pradaxa.

Many of the patients who take these anticlotting drugs may be too sick systemically to undergo what would otherwise be simple outpatient surgeries done in our offices. If there is any doubt as to your patient’s health status, or you are uncertain whether there may be a health risk or bleeding problem after a procedure that you are recommending, do not hesitate to contact the patient’s physician before performing the procedure. DO NOT advise your patient to discontinue taking any physician prescribed medications in an attempt to better control post-operative bleeding. Consider your local medical laboratories as an information resource. They are more than happy to answer any questions you may have concerning the appropriate tests and ranges for your patients’ medications and the procedures you are recommending. Finally, as new medications arrive on the market and show up unrecognized in our patients health histories and history updates, don’t be afraid to ask your patient what the drug is for, why they are using it, and what their daily dosage is.

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TRUSTEE REPORT

Highlights from February BOT Meeting

By Dr. Brian Cilla, MDA Trustee and complexity of the issues facing the MDA with regard to the proposed 2014 budget, the dues amount, and the need for flexibility in the decision-making process. A resolution will be forwarded to the 2013 HOD which would grant the MDA BOT the authority to set the 2014 dues at up to the current 2013 dues amount, for the purpose of maintaining a balanced budget.

A

s I write this current report, we are in the beginning stage of March Madness (basketball and Washington, DC). The MDA Annual Session is just around the corner. This year’s event theme is the “Spirit of Michigan” and will be in Novi on April 17-20. There are three days of CE courses and nearly 200 exhibits. Please make plans to attend this meeting. Of special note, Dr. Norm Palm will be our incoming MDA President. May it be smooth sailing for the next year. However, we all know that Norm will be ready for anything that comes his way. Wish him success with his tenure as the President.

This report contains highlights from the February Board of Trustees (BOT) meeting.

MDA Budget Determining the annual budget for the MDA is a complex process. Non-dues revenues, generated by the MDA Insurance and Financial Group (IFG), are an important component of the MDA annual budget. We are very fortunate that MDAIFG has experienced continued, ongoing growth over the years. The revenues generated by these programs have provided significant dues relief for our members. At the present time, the projected MDA budget is essentially balanced.

However, we are at a crossroad with the unknown. The insurance exchanges dictated by the Affordable Health Care Act may, or may not, impact a significant portion of our nondues revenues. As a consequence, at the most recent BOT meeting, there was much discussion and deliberation regarding the upcoming MDA budget. The Board has asked that background information be sent to the 2013 MDA House of Delegates (HOD) so that the delegates understand the timing 4

MDA Membership At our last meeting, it was resolved that, for working life members, the annual dues and contributions toward any MDA assessments shall be 75% of an active member. This policy is consistent with current ADA policy.

Nationally, the MDA remains at the forefront in providing membership value. According to the MDA’s 2012 year-end membership report, our Association ended last year with a 76.5% market share, up .3% from year-end 2011. 79.2% of dentists under the age of 40 are members of the MDA. MDA Governance Our MDA by-laws require a periodic review of governance.

At the present time, the MDA is operating with a governance structure modeled in the 1970s. As a consequence, a work group has been formed to review the MDA. Dr. Michael Gallery is the consultant and facilitator for this group. A meeting was held in January in order to begin discussions on potential solutions to where MDA performance is versus where the MDA should be (gap analysis). Recommendations have not yet been formulated because there are many possible solutions and the work group wants input from the House and membership regarding the performance requirements and gaps. As a preliminary step, the 2013 HOD will be asked to adopt resolutions regarding these parameters. As part of this process, Drs. Michael Gallery and Joanne Dawley will provide a presentation to the House and there will be an opportunity to ask questions. At the reference committee hearing there will be testimony on the performance requirements and gaps. Once feedback is received from the House, the work group will then be able to formulate solutions and/ or recommendations. These will be presented at the June BOT meeting. It is anticipated that there will be a special meeting of the House of Delegates on September 20, 2013 for the specific purpose of governance review.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

TRUSTEE REPORT

Department of Community Health The director of Michigan Department of Community Health (MDCH), Mr. Jim Haveman, provided the BOT with an update on the department. Mr. Haveman reviewed the MDCH budget recommendation for 2014 and strategic priorities. It was reported that Medicaid expansion is supported by Governor Snyder. This expansion will add 370,000 to Medicaid and provide health care for low income people.

Initially, 100% of the costs for this expansion will be funded by the federal government for the first three years. At the present time, there are 1.2 million uninsured individuals in Michigan. It is anticipated that increased coverage will keep these individuals out of the emergency rooms and also provide for medical homes. Adult dental care is not included in this plan. As part of the process, a Federal/Sate Insurance Exchange will be established. The Federal government will be providing $30M to begin working on the Exchange. If Michigan does not act on the $30M, the Federal government will run the exchange and bill Michigan for costs associated with running the exchange. In order for this to occur, Michigan must first create a new computer system. Michigan will spend about $150M to upgrade its current system to be compatible with the new exchange. It is anticipated that it will take 3-4 years to get all of the kinks out of the system. A question was raised as to how the department plans to work with the Medicaid population in order for these individuals to take personal responsibility for their own health care. Mr. Haveman is aware that solutions for this complex problem are difficult and that any and all ideas are welcome. He asked that input be provided to Bill Sullivan, who can then relay them to MDCH. Healthy Kids Dental The Governor, on February 7, presented his 2014 state budget. Previously, the Governor has proposed expanding Healthy Kids Dental (HKD) program to the entire state.

Due to budget realities, the plan has been for an incremental phase-in of HKD. There is an expected completion date of 2016. Ten counties were included with the first expansion in 2013. The proposed 2014 budget for HKD includes $11.6 million, of which $3.9 million is from the state and $7.7 million will be federal. It is anticipated that the following counties WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

will be added to HKD: Ingham, Ottawa, and Washtenaw. The budgets for Donated Dental Services will remain same as last year ($151,000). Adult Dental Medicaid will receive $7M in state funds and $14M federal matching funds.

Mission of Mercy (MOM) Dr. Stephen Harris, chair of the MOM project, provided the Board with an update on the 2013 project. The event will be held June 7-8, 2013 at the Ryder Center at Saginaw Valley State University. The MDA has exceeded its financial goals for this 2013 event. Monies remaining will be transferred to the 2014 event. There are currently over 400 volunteers. Dental volunteers are still needed. Dentists can sign up to volunteer from the MDA’s website.

Future MOM projects The MDA Board has voted to do another MOM in May of 2014. If everything goes as planned, it will be held May 29 to June 1 at Ferris State University. It is anticipated that the MDA Foundation will again partner with the MDA on this venture. The MDA will be monitoring the success of these projects in order to determine the frequency and locations for future events.

Legislative Advocacy Everyone has received a mailing from the MDA regarding the importance of legislative advocacy. The MDA is encouraging our members to be active in the political process. There is easy access to contact information on the MDA website.

We have our next WMDDS Legislative Breakfast on Friday, April 26, 2013 at Frederik Meijer Gardens & Sculpture Park. Please mark your calendar and make plans to attend this year’s WMDDS Legislative Breakfast. This is an important opportunity for you to meet local legislators and express your views and concerns on the issues that affect dentistry. Please make every effort to attend. Dentistry’s voice needs to be heard by our local representatives.

Since access to care has become such a prevalent local and national topic of discussion, the MDA plans to hire our current intern, Stephanie Olds, to promote the many good things that dentists are doing in their communities. She will be attending local components to cover access events and

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TRUSTEE REPORT

continue to send MDA Twitter feeds. Additionally, Stephanie will work with local components on creative marketing opportunities.

Topics of Local Interest The Kent County Health Department (KCHD) has reported that the funding is in place to begin construction of the new, ten-chair dental clinic in Kentwood. Spectrum Health has funded a “dedicated chair” at the KCHD Clinic for Spectrum Emergency Department dental referrals.

Blue Cross has given a $200,000 grant to establish a new dental program at the Federally Qualified Health Center operated by Saint Mary’s Health Care. The FQHC clinic, operated by the Peoples Health Centers of Michigan will include five

operatories and will be located at Hope Network’s campus on 36th Street. The People’s Health Centers of Michigan is a non-profit collaboration of Saint Mary’s Health Care, Hope Network, and Metro Health.

Finish As always, I welcome any questions, concerns and/or commentary regarding the activities of the MDA. Do not hesitate to call, write or e-mail (blcilla@aol.com). In the meantime, enjoy the longer days and any of our nice spring weather.

2013 New Dentist Forum Golf Outing Friday, September 6 — Noon Shotgun (the first week back at school when you can roll a bowling ball through our offices and not hit anyone!)

Quail Ridge Golf Course in Ada Loads of prizes, contests and fun!

Registration forms to be mailed in June For sponsorship information, contact Devin Norman: drd@nfdentistry.com

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

Legislative Breakfast Friday, April 26, 2013 Frederik Meijer Gardens & Sculpture Park 1000 East Beltline NE Grand Rapids, MI 49525 Please mark your calendar and make plans now to attend the WMDDS Legislative Breakfast.

This is an important opportunity for WMDDS dentists and local legislators to meet and express views and concerns on the issues that affect dentistry. Please make every effort to attend.

To reserve your place, please complete and return the attached form by April 18, 2013.

Name

Email address

Breakfast Buffet will be served starting at 8:00 am Cost: $16 per person Please make check payable to: West Michigan District Dental Society Return by April 18, 2013 to: West Michigan District Dental Society 161 Ottawa Avenue NW Suite 511-F Grand Rapids, MI 49503 Questions? Contact Elaine Fleming 616.234.5605 | efwmdds@aol.com or Dr. Steve Dater, WMDDS Legislative Chairperson 616.866.0869 | smdater@comcast.net

CLINICAL NEWS

A Brief Primer and Literature Review on Crown Lengthening Surgery

By Dr. Jeff Smith, WMDDS Editor

H

ow often has one of your patients asked you if there is anything that can be done to make their teeth look larger or their smile less gummy? We all have patients with short clinical crowns and/or a high lip line that exposes a broad band of gingival tissue when they speak or smile. Crown lengthening surgery can be done to increase the length of the maxillary teeth in an apical direction, and at the same time decrease the amount of visible gingiva. Crown lengthening surgery is also used in situations of sub-gingival decay, crown fractures, altered passive eruption, severe attrition, or where the height of the crown is deemed inadequate for retention without extending the restoration deep into the periodontal tissues.1,2,3 In 1961, Garguilo defined the biologic width as the combined width of the epithelial and underlying connective tissue attachments that comprise the dentogingival junction. Since each averaged 1mm, the biologic width was about2mm with a gingival sulcus about 0.7mm deep.4 Nevins and Skurow included the gingival sulcus depth, so the biologic width became approximately 3mm.5 Any impingement of the biologic width by a restorative margin can result in gingival inflammation, pocket formation, and alveolar bone loss.6,7,8 Gingival health and form after placing a sub-gingival restoration depends upon non-impingement of the biologic width, tooth shape, and a smooth, continuous emergence profile that does not disrupt the cervical wall of the supra-crestal gingival tissue.

When crown lengthening is done to alter the shape and size of maxillary teeth, it can involve gingivectomy, osseous surgery, orthodontic extrusion, or any combination of these.

Before proceeding with any periodontal or restorative treatment, the following factors must be considered: 8

1. Location of the gingival margin in relation to the CEJ and alveolar crest, 2. Crown to root ratio, short tapering roots, and alveolar bone relationships, 3. The size and shape of the upper lip, 4. The location of the lip line during speech and relaxed smiling, 5. Aesthetics, 6. Predictability and maintainability, and 7. Comparison of the adjacent periodontium to provide a continuous transition between lengthened and nonlengthened teeth.9,10 If the width of the free gingiva is greater than 1mm (i.e. the clinical crown is shorter than the anatomical crown), and the patient displays a periodontium of the thin biotype, then full exposure of the crown may be possible with gingivectomy.

If the periodontium is of the thick biotype, then an apicallypositioned flap (with osseous surgery if necessary) should be done. In patients with short anatomical crowns, more extensive bone reduction and root exposure may become necessary. Crowns or veneers then must be used to increase the apical-incisal dimension of the clinical crowns.

Patients with normal occlusion and incisal guidance should not have the positions of their incisal edges altered. Their crowns are made longer by surgically exposing root structure, and the cervical margins of the restorations are placed on the roots. Crown length is then limited by the aesthetic height to width ratio of the teeth. In patients who exhibit an anterior overbite, the incisal edges of the teeth may be repositioned apically in addition to the cervical margins to preserve an ideal height to width ratio of 1.2 to 1 without interfering with incisal guidance.11 Bony recontouring alone may not be the best choice for single teeth, especially in the maxillary anterior region where symmetry is critical, or where removal of bone from adjacent teeth should be avoided. In these cases orthodontic extrusion can be used to bring the tooth down to a distance equal to or slightly greater than the portion of sound tooth structure that will be exposed with subsequent osseous surgery. This extrusion can be slow or rapid.12,13,14,15 After bony crown lengthening is completed on extruded teeth, the final position of the free gingival margin is harmonious with the adjacent teeth.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

CLINICAL NEWS

When crown lengthening is performed, a 3 to 4mm distance between the alveolar crest and the restorative margin is essential to allow the necessary space for healthy dentogingival tissue. In the absence of periodontal disease, transcrevicular probing or “sounding” with local anesthesia can be done to insure that there is adequate distance between the proposed restorative margin and alveolar crest after crown lengthening is completed. Margins should be placed halfway down the sulcus or about ½mm if possible.16 Bragger and others have demonstrated that a 3mm biologic width remains stable up to 6 months.17,18 Other studies have reported that there can be 1mm or more gingival “rebound” coronally, especially in thick tissue biotypes.19,20 In aesthetic cases, it may be prudent to keep patients in temporaries for an adequate time period (normally 12-14 weeks) to insure that the free gingival margins are in their final position before final restorative margins are placed and impressions taken. Wound healing studies in monkeys suggest that the biologic width re-establishes itself following crown lengthening procedures.

The junctional epithelium will migrate to the level of root planning, and the space for supra-crestal connective fibers is created by resorption of alveolar bone.21 When crown lengthening is done, the final alveolar contour should parallel the CEJ or proposed margin of the restoration.

On posterior teeth the alveolar bone should be relatively flat, whereas the bone around anterior teeth will assume more of a “saddle” form, being more coronal interproximally, as it circumscribes the tooth.22 One of the most difficult challenges in periodontics and aesthetic dentistry is closing or repairing areas where the papillae have receded or are not present due to excessive interproximal distance between the teeth. There are no predictable ways to graft or rebuild these papillae once they are gone. Tarnow stated that if the interproximal contact points of the teeth are within 5mm of the alveolar bone, the papillae will usually regenerate and fill any “black triangles.” 23 This should be kept in mind during the surgical phase so that no more interproximal bone is removed than necessary. Black triangles can be closed by raising the interproximal contacts of the crowns apically, however, this can cause the teeth to look unaesthetically “square.” This is especially true in patients whose natural crowns are more round or “bell” shaped.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

In an ideal aesthetic situation in the anterior maxilla, the height-to-width ratio of the crowns should be between 1-1.2 to 1. The central incisors should be symmetrical, and in line in height and position. The heights of contour at the cervical areas should be located at the disto-labial line angle to avoid the appearance of “chiclet-like” teeth. The free gingival margins of the cuspids and centrals should all be on one line that parallels another line bisecting the patient’s pupils. The free gingival margins of the laterals should be 1-1.5mm incisal to those of the cuspids and centrals.24 Finally, when treatment planning a case for aesthetic crown lengthening, it is helpful to gather photos of your patient while smiling, when their lip is at rest, as well as with cheek retractors. Upper and lower study models are useful for determining incisal guidance. A diagnostic wax up on the models can also be used to present the proposed case to the patient. Radiographs are also necessary to verify that if osseous surgery is required for the case, that the crown to root ratio of the teeth to be lengthened, or the bony support around adjacent teeth is not compromised.

Bibliography 1. Smukler H, Chaibi M, Periodontal and Dental Considerations in Clinical Crown Extension: A Rational Basis for Treatment. IJPRD 1997: 17:465-477.

2. Carranze, F. (1990) Glickman’s Clinical Periodontology, 7th Edn. Philadelphia: W.B. Saunders Company, pp. 921-923.

3. Cohen, E. (1994) Atlas of Cosmetic and Reconstructive Periodontal Surgery, 2nd Edn. Philadelphia: Lea and Febiger, pp. 263-383.

4. Garguilo A, et al, Dimensions of the Dentogingival Junction in Humans.

JPerio 1961; 32:261.

5. Nevins M, Skurow A, The Intracrevicular Restorative Margin, the Biologic Width, and the Maintenance of the Gingival Margin. IJPRD 1984; 4:31.

6. Newcomb G, The Relationship Between the Location of Subgingival Crown Margins and Gingival Inflammation. JPerio 1974; 45:151-154.

7. Bensimon G, Surgical Crown – Lengthening Procedure to Enhance Esthetics. IJPRD 1999; 19:332-341.

8. De Waal H, Castelluci G, The Importance of Restorative Margin Placement to the Biologic Width and Periodontal Health. Part 1. IJPRD 1993; 13:461-471.

9. Lindhe, J. (1989) Textbook of Clinical Periodontology, 2nd Edn. Munksgaard, pp. 487-496.

10. Rosenberg E, Garber D, Tooth Lengthening Procedures. Compen.

Contin. Ed. Gen. Dent. 1980; 1:161.

9

CLINICAL NEWS

11. Garber D. (1987) Periodontal Esthetics Problem Solving-Unique Problems Require Unique Solutions. Presentation, D. Walter Cohen Periodontal Symposium, University of Pennsylvania, Philadelphia.

12. Pontoriero R, et al, Rapid Extrusion with Fiber Resection: A combined Orthodontic-Periodontic Treatment Modality. IJPRD 1987; 7:30-43.

13. Reitan K, Clinical and Histologic Observations on Tooth Movement During and After Orthodontic Treatment. American Journal of Orthdontics 1967; 53:721-745.

14. Ingber J, Forced Eruption: Part 1. A Method of Treating Isolated One and Two Wall Infrabony Osseous Defects – Rationale and Case Report.

JPerio. 1974; 45:199-206.

15. Guilford H, et al, Vertical Extrusion: A Standardized Technique.

Compen. Contin. Ed. Gen. Dent. 1984; 7:562-568.

16. Ingber J, et al, The ”Biologic Width”, a Concept in Periodontics and Restorative Dentistry. Alpha Omegan 1977; 70:62-65.

17. Lanning S, et al, Surgical Crown Lengthening: Evaluation of the Biologic Width. JPerio 2003; 74:468-474.

18. Bragger U, Surgical Lengthenung of the Clinical Crown. J. Clin. Perio.

1992; 19:58.

19. Pontoriero R, Carnevale G, Surgical Crown Lengthening: A 12-Month Clinical Wound Healing Study. JPerio 2001; 72:841-848.

20. De Waal H, Castelluci G, The Importance of Restorative Margin Placement to the Biologic Width and Periodontal Health. Part 2. IJPRD 1994; 14:70-83.

21. Oakley E, et al, Formation of the Biologic Width Following Crown Lengthening in Nonhuman Primates. IJPRD 1999; 19:528-541.

22. Davarpanah M, et al, Restorative and Periodontal Considerations of Short Clinical Crowns. IJPRD 1998; 18:424-433.

23. Tarnow D, et al, The Effect of the Distance From the Contact Point to the Crest of Bone on the Presence or Absence of the Interdental Dental Papilla. JPerio 1992; 63:995-996.

24. Lowe R, Esthetic Restoration of the Maxillary Anterior Region: A Case Report. IJPRD 1989; 9:354-363.

MARK YOUR CALENDAR West Michigan Dental Foundation Annual Golf Outing Friday May 31, 2013 Egypt Valley Country Club Watch for registration forms to arrive in April.

Mission Statement: An organization dedicated to the improvement of oral health through the financial support of education and service programs to address the needs identified by the dental profession and the communities it serves in Kent, Ottawa, Ionia, Mecosta and Montcalm counties.

10

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

t e g r o f t ’ don s e s a c 3 iu m d e m f o g lo ve s Your expertise in crown technology restores smile after smile.

But do you know where to get the best deal on quality exam gloves?

We do. We offer: • Special association-member prices • Help to find the fit, feel and comfort your whole dental team needs • 60 different gloves from seven leading brands • No-risk, 100% satisfaction guarantee • Inventory control program Find out what thousands of Michigan dentists already know. Get exam gloves and masks through the most trusted and knowledgeable source.

To place an order, request free samples, or for more information, please contact us at 877.484.6149. To order gloves online, visit mdaservicesgloves.com.

Visit mdaprograms.com or call today at 877.484.6149.

Catch the Spirit in Novi!

MDA 2013 Annual Session Suburban Collection Showplace, Novi • April 17-20, 2013

Michigan Dentistry’s Biggest CE Event!

20

AP

0,

I

V

Plus keynote speaker CONNIE PODESTA and others

NO

Scott Benjamin, DDS Joseph Best, DDS, PhD M. Douglas Campbell W. Choong Foong, PhD Mary Govoni, RDA, RDH Derek Hein Timothy Kosinski, MS, DDS Glenn Lombardi Susan Maples, DDS Alan Mead, DDS Kenneth Myers, DDS William Nudera, DDS, Ms Christopher Smiley, DDS Jon Suzuki, DDS, PhD, MBA Domenica Sweier, DDS, PhD Anastasia Turchetti, RDH Stephen Ura, DDS Kelli Vrla Daniel Ward, DDS

13

SPEAKERS INCLUDE:

2 7 RIL 1

Pre-Register Early!

Online registration now open! www.smilemichigan.com\pro Join your colleagues for great social events, a variety of topics and speakers and nearly 200 exhibits.

New this year — one hour “Hot Topic” sessions — more information coming soon.

“Dentists are dealing with many unknowns...

One thing I am certain about is my malpractice protection.”

Many dentists are feeling the impact of lowered demand for dentistry due to the economy.

Profitability challenges and increased risk to meet those challenges contribute to an atmosphere of uncertainty and lack of control.

What we do control as dentists: our choice of a liability partner.

I selected ProAssurance because they stand behind my good dentistry. In spite of the maelstrom, I am protected, respected, and heard.

I believe in fair treatment—and I get it.

Professional Liability Insurance & Risk Management Services ProAssurance Group is rated A (Excellent) by A.M. Best.

ProAssurance.com • 800.292.1036

Happier Patients— One Compound at a Time

Keystone Pharmacy, your accredited compounding experts!

Using the latest technology and purest ingredients, we create custom medications for your patients, which are prescribed by you and conveniently delivered to your patient’s home.

Call our pharmacist today! creams & gels • gummies, lollipops & lozenges sterile medications • suppositories, sprays and more

KEYSTONE PHARMACY Specializing In Your Health

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Your practice depends on the individualized service you provide each and every client. So does ours.

Tax Planning and Preparation

IRS Representation

Sales and Use Tax

With extensive hands-on experience in the healthcare industry, our team focuses on the financial and operational challenges you face everyday. We are committed to providing industry-specific expertise relevant to you, without compromising your patient focus.

Accounting Software Installation and Support

Retirement Plan Design and Administration

For more information please visit BeeneGarter.com or contact Brian LaFrenier at (616) 235-5200.

Bookkeeping and Assistance Start-Up Consulting Choice of Entity Analysis Cash Flow Projections

Payroll Processing

Human Resources Succession Planning Business Valuation Estate Planning and Wealth Management

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Evolving your practice today for a healthier tomorrow.

Overhead Analysis

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

We need your help!

Thursday, June 6, 2013 Set up clinic Friday, June 7 and Saturday, June 8 Clinic open to all Sunday, June 9 Tear down clinic For information contact Lori Kleinfelt or Andrea Sundermann at 800-589-2632 or via email at mom@michigandental.org.

TECHNICALLY SPEAKING

Windows 7 or 8?

Submitted by Greg Feutz, President, DDS Integration

Greg Feutz is President of DDS Integration, a Grand Rapids based dental technology company.

I

n each WMDDS Bulletin I will be fielding your questions about technology, its place in the dental practice, and beyond.

Send your questions to askgreg@ddsintegration.com and I’ll answer them on my blog, facebook, and in each Bulletin.

I’m ready for a new computer.

Windows 7 or Windows 8?

My answer: Windows 7. Why? Windows 7 is stable, reliable, and considered to be the industry standard right now.

Support for Windows XP finally ended (and XP was released 12 years ago) so there is plenty of life left in Windows 7.

Now, Windows 8 is very cool and may someday become the standard, but it may also suffer the fate of Vista and lead a very troubled and short life. It’s too early to say at this point. However, none of that matters nearly as much as compatibility.

As you know, each of your software and hardware vendors specify system requirements that your computers must abide by in order to successfully use their product. Eaglesoft, Dentrix, Softdent, Dexis, Tigerview, etc.… all have these requirements – and guess what? Hardly any of them currently support Windows 8. How fast will that change? Good question, that’s kind of like asking how long it will be before Dentrix or Eaglesoft put any of the changes you’ve undoubtedly requested into their next update. Because we can’t predict or influence how fast and in what direction these vendors move, Windows 7 is the safe bet for now.

Consider this as well: Windows 8 is basically brand new.

Remember back to one of the times you did your Practice Management Software version update right away. Were there bugs? Was it a headache? How long did it take before every 16

thing worked the way you wanted to again? My approach is that it just isn’t worth the hassle of being a first adopter. Sure, Windows 8 has been tested as extensively as possible prior to releasing to the public, but the best test of all (with any product) is to release it to the public and see what happens. This is why we have service packs and patches and such, to fix all of the problems the first adopters were kind enough to find.

Someone has to be the first adopter, but I’d rather it not be me or you.

Let’s be fair…Windows 8 is initially showing to have great potential. I myself have it installed on my laptop in a virtual machine environment and I have had no problems with it. The interface is considerably different but in general can be navigated by someone who can find their way around Windows 7. I do think it’s going to take off in the next few years, especially if the tablet market supports it.

Speaking of tablets, another plus for Windows 8 is its interface for touchscreen monitors, laptops, or tablets.

Touchscreens on Windows 7 is a nice idea and works OK, but Windows 8 is built for it. It’s more like using an ipad but on your computer, it is just so much more intuitive than Windows 7 for the touchscreen user. I am very excited to someday use Windows 8 with touchscreens, navigating between my 5 monitors (yes I’m that geeky) will be easier when I can just touch the spot I want to go to rather than mousing and mousing and mousing to get there. If you’ve seen the Matrix or Avatar, those touch screen interfaces are what I envision Windows 8 doing for the PC; it truly could be a game changer. I also see these Windows 8 tablets as soon being an answer to the demand for tablets in Dental Practices.

Notice I did say soon, we still have to wait on our good old vendors to become Windows 8 compatible.

But Greg, what if I’m not going to use it in my practice at all and just want to use it at home? I’ve pondered this myself, which is why I have it running in a virtual machine on my Windows 7 computer. If you like to tinker and enjoy the adventure of new adventures, go for it! To keep a stable and reliable Windows 7 computer intact, install Windows 8 in a virtual environment or as a dual boot option. Then you get the best of both worlds! For those of you who are perfectly happy to let us curious souls figure it all out, keep enjoying Windows 7, and your free time.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

TECHNICALLY SPEAKING

What are your thoughts?

Comment on our blog or facebook article. We’d love to hear your opinions on Windows 7 vs. 8 or any other topic. If you have tried out Windows 8, share your experience. We’re excited to see what other people think!

Facebook: facebook.com/ddsintegration Blog: ddsintegration.com/blog

The Points of Light project

If you would like more information regarding our project or would like to register as a participant, please visit our website at: pointsoflightonline.org.

Disability Income Insurance

For a clearer view of your insurance and a free, no-obligation quote, call Molly Murray today at 616.301.2599!

that’s clear as day.

• Are you comfortable with your policy?

• Are your benefits clear to you?

• Have you really compared it to what is available today?

Molly Murray GreAT LAkes FInAnCIAL InsurAnCe AGenCy Licensed expertise in:

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www.theinsuranceforprofessionals.com WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

17

Why all the Fuss about

Airways and Faces?

Be Inspired May 2-4, 2013

Allerton Hotel- Downtown Chicago Pre-symposium Thurs. 1-5 pm Dentists: $190.00 Staff: $45.00 Main Symposium Fri. & Sat. 8-5pm Dentists: $1115.00 Staff: $375.00 Continental Breakfast and Lunch included Fri. & Sat. Banquet Fri. evening included

DDS, Allen Moses, DDS ( inventor of ‘the Moses” appliance for snoring and OSA), Stephen Sheldon, DO ( pediatric sleep medicine),Phil Losavio, MD- ENT, William Hang, DDS, Christine Mills, BS, John Flutter, DDS, Bertrand da Silva, MD

Call the office of Karen O’Rourke, DDS for more information and registration details. (616)455-7930

Fourfold increase in airway

Good Ideas for Dental Practices

5

Good Idea # in a series of 15

“Is your practice attractive to new associates?

Will they earn enough to afford the payments to you and/or the bank? When it is time for you to bring in an associate, analysis should be done to answer these questions.”

For 14 more Good Ideas from Hungerford, please email Rick Chrisman at rchrisman@hanc.com, or call Rick at (616) 949-3200.

18

HANC Ad for the Bulletin

2/13/13

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Speakers include: John Mew, Michael Mew, Michael Gelb,

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Member Get A Member

Building the future of our profession … together!

Share why you belong to the #1 organization representing all dentists.

As an active member, you know first-hand the value of a strong ADA — greater recognition for the profession, more resources for members, and a louder voice in Washington and across the country.

Most ADA members say they would recommend membership to colleagues. Now, here’s your chance!

ADA Member-Get-A-Member Any ADA member dentist is eligible to participate in the 2013 ADA Member-Get-A-Member Campaign.

With your help: • The ADA benefits by being able to represent another member dentist.

• The new member you recruit benefits by taking advantage of all membership has to offer.

• You benefit by strengthening the ADA and sharing the value of membership with another colleague — plus there are incentives and prizes for recruiters! For details visit ADA.org/MGAM. Recruiting is Rewarding You will be rewarded with a $100 American Express gift card for each new, active member you recruit (up to five members or $500 in American Express gift cards)! Or you may decline the incentive and ADA will contribute $100 to the ADA Foundation. Please see Campaign Rules for full details at ADA.org/MGAM. Participate in the 2013 Member-Get-a-Member Campaign and help build the future of our profession!

Don’t Delay! The ADA Member-Get-A-Member campaign runs through September 30, 2013. For resources to assist your recruiting efforts, plus complete guidelines and rules visit ADA.org/MGAM, send an email to mgam@ada.org or call the ADA Member Service Center at 800.621.8099.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

19

PRACTICE MANAGEMENT

Do You Know What Your Dental Practice Is Worth?

Submitted by Richard L. Chrisman, CPA MST Hungerford, Aldrin, Nichols & Carter, PC 2. Market Comparison – This method identifies similar practices that have been sold and applies certain ratios of those recent practice sales to the practice being valued.

This is like determining the value of a house by looking at what similar houses have sold for.

3. Income/Cash Flow Based – This method identifies the cash flow being generated by the practice, and then the cash flow is either capitalized, discounted or multiplied.

A

nyone who has ever bought or sold a dental practice knows that buyers and sellers often have a very different perspective on what a practice is worth.

A seller typically believes that his/her practice is worth more than it really is. Meanwhile, the buyer is looking for a bargain.

Since a sale cannot occur until a purchase price is agreed to, both parties are often motivated to find a number that is fair to everyone.

Unfortunately, there is no standardized generally accepted method for valuing a dental practice. There is no rule of thumb that enables someone to determine a fair value by simply looking at a few numbers and making a calculation.

There is no “right” or “easy” way.

The reality is – determining a fair value of a dental practice is a difficult task with many complexities. There are many objective and subjective factors that need to be considered.

When a practice valuation is necessary, it is a good idea to get a valuation expert involved. An expert knows what information to look at and how to interpret it.

Common valuation methods Every practice is unique. The valuation method that should be used to arrive at a fair value will depend on the facts and circumstances of the particular practice. Although there are many methods used to value a dental practice, most approaches tend to fall into one of three categories: 1. Asset Based – This method calculates the value of the assets of the practice being sold. This is often a good place to start. It gives you an idea of what the cost would be to start up a similar practice by purchasing the necessary assets. The shortcoming of this method is that the income and cash flow of the practice are not considered.

20

In most situations the experts tend to favor the Income/Cash Flow Based approach because it recognizes the components that are critical to the ongoing success of the practice. This method will enable the buyer to purchase a practice for a price that is based on the expected income and cash flows of that particular practice. The buyer will also have a good understanding of his ability to make any required loan payments to the bank or prior owner.

Some factors that need to be considered when doing a valuation Valuation experts will look at the following items among others when preparing a valuation of a practice.

11. The results reported on recent financial statements and tax returns.

12. A list of equipment and an estimate of its value.

13. The cost and age of leasehold improvements.

14. A production and collection report by each dentist and hygienist.

15. An accounts receivable aging and collections report.

16. Any contracts that are in effect.

17. The total number of active patients.

18. The value of intangible assets.

19. The economic and industry outlook.

10. What is the reason for the owner to want to sell the practice?

Other considerations when buying or selling a practice It is common for buyers and sellers to get emotionally involved in the negotiation of the purchase price. However, the devil is in the details. Most compromises on value are ultimately achieved through the terms of the agreement. Besides WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

PRACTICE MANAGEMENT

the purchase price, there are two other major issues that need to be agreed to: 1) What exactly is being purchased? i.e. stock or assets, and 2) What are the payment terms of the sale? i.e. cash and/or financing.

The cash flow and tax effects can vary significantly (to both the buyer and seller) based on the terms. Therefore, to be sure there are no surprises later, you should involve your CPA in the negotiation of the details of the transaction.

If you are selling a practice, make sure you know 1) What cash you are going to receive from the buyer, 2) When are you going to receive it? 3) How much in taxes will be owed?

4) When will those taxes need to be paid? and 5) How much cash will you ultimately end up with after the taxes are paid?

Make sure you understand and are comfortable with all those numbers.

If you are buying a practice, make sure you understand what risks you are taking, the purchase price is fair, and you know where the cash flow is going to come from to meet the terms of the purchase. The purchase of a practice will not go well for the buyer if he overpays for it or the terms are not manageable.

Richard L. Chrisman, CPA, MST is the Managing Shareholder of Hungerford, Aldrin, Nichols and Carter PC, a Tax, Auditing and Business Consulting firm with offices in Grand Rapids and Greenville, MI. The firm is celebrating 71 years of helping local businesses, including many area dental practices.

Born here.

Growing here.

The passion to do more.

Our local bank proudly supports the West Michigan Dental Community.

Locations

Specialties Include: • Custom designed deposits • Equipment financing • Financing of partner buy-in and practice purchase

Staying here.

• Flexible loan payments • Practice start-up loans • Real Estate Financing • Working Capital Lines of Credit

Member FDIC

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

Cascade Rd at Spaulding - SE Northland Dr at Plainfield - NE Monroe Ave at Louis - Downtown Wilson Ave at 56th - SW

(616) 956-9030 foundersbt.com

21

CLASSIFIED ADS

The classified ad rate is $10.00 up to and including 30 words; additional words 15¢ each. Space permitting, WMDDS members may place ads free of charge as a membership service. Ads should be submitted in writing and sent with payment to Elaine Fleming, WMDDS, 511-F Waters Building, Grand Rapids, MI 49503. Telephone numbers and hyphenations count as two words, abbreviations count as one word. Ads received after the first of the month prior to publication may appear in the following issue.

Established Dental Office Space – 2003 Burton SE (between Breton and Plymouth). End unit with 720 sq. ft. and a full basement, on-site parking, adjacent 3 spaces occupied by established dentists. Great traffic counts on Burton in an established residential area. Call Bruce at 942.9492.

Dental Office for Lease – with immediate availability. Near the “medical mile” on primary road with high traffic count and super visibility. Has been a dental office for over 40 years. Very good lease terms/rates. Would make awesome start-up or satellite. For more info, email ronaldpr@sbcglobal.net.

Seeking Employment – General dentist with several years of experience seeking part-time employment in the West Michigan and surrounding areas. Proficient in all areas of general dentistry. A team player. Please reply to dentaljobwmi@hotmail.com.

General Dentist – Looking to purchase a practice or pursue transition in Grand Rapids area. Three years of experience. Please email to: mkflores80@yahoo.com.

Dental Office for Lease – Time to move up? Busy northeast area dental suite at 1750 Grand Ridge Ct. NE, 3295 SF, ten-year old modern dental office available. 3 pvt ops, 4 chair bay area, plumbed for nitrous, air, water, power and vacuum, lab, x-ray, staff area, pvt. office, reception, storage available. Former pedo practice obtainable Jan. 1st 2011. Contact Dr. John Monticello 616.364.1700 or info@grandridgeorthodontics.com

Associate Position Wanted – Fourthyear at University of Florida COD and Michigan native seeking full-time

associate level opportunities in greater Grand Rapids area beginning summer/ fall 2013. LRULE@UFL.COM or 248.568.0839.

Seeking employment – General dentist with eight years of experience seeking part-time employment in West Michigan area. Enjoys practicing most areas of dentistry. Please email: dentalassociatemi@hotmail.com.

Dentist Needed – Full-time or parttime at State of Michigan Correctional Facility in Ionia, MI. Avoid headaches of private practice. For information please call Ken or Richard at 517.321.9313.

Ottawa County Health Department is currently in the process of recruiting a part-time dentist to provide services on the county’s 40 foot, state-of-the-art “Miles of Smiles” Mobile Dental Unit. The mobile unit provides comprehensive dental services at schools and Head Start Centers throughout Ottawa County (Grand Haven, Holland, etc.). Please see attachment for additional information regarding this exciting career opportunity!

Employment will involve 1-2 days per week (6 hours/day). Competitive wage.

Associate position wanted – Newly graduated dentist from UDM looking for full time position as an associate of progressive dental practice in Grand Rapids and surrounding areas.

Please call 616.617.9725 or email ranaazzo@gmail.com.

For Sale – Lab Master Foster Model Trimmer, Model # MT115, like new $600. Contact 616.949.7510.

22

If you are interested in this position, please e-mail a resume to: dbassett@miottawa.org.

Debra J. Bassett R.D.H., B.H.S. Oral Health Team Supervisor Ottawa County Health Department 12251 James Street, Suite 400 Holland, MI 49424 We look forward to hearing from you!

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

CLASSIFIED ADS

Beautiful, Professional Suite Available for Sale/Lease – N.W. Michigan, lower peninsula, in a growing community. Great opportunity for any dentist, with many extras. Ideal location, safe and serene, for any family. World-class cultural events, restaurants and attractions nearby.

Sporting adventures abound.

Turn-key. Let’s talk. Call 231.313.8407 or jarickert@charter.net Exciting Opportunities – for dentists to provide children with dental care in Grand Rapids area schools. No evenings or weekends. Apply at smileprograms.com or call Tracey at 888.833.8441, ext. 126.

Kavo Handpieces for Sale – 6000B have 5 at $400/handpiece, 6500B have 6 at $400/ handpiece, 647B have 8 at $200/handpiece, 640B have 2 at $200/handpiece, 649B have 2 at $200/handpiece.

Call 616-453-6323.

For Sale – Kavo GentleRay 980 Diode LASER. Specializes in management of all soft tissue procedures such as gingival troughing, aphthous ulcer treatment, and perio pocket treatment as well as bleaching. Features a large, bright touch screen with built in clinicial tutorials for easy practice integration. Like new, used approximately 15 times. Includes ALL accessories needed for immediate use including protective eyewear for doctor, patient and assistant and 3 tips for handpiece.

Also includes rolling cart for portability. Please call or email for details/

photos. Phone 616.606.3263, or email dandersen83@gmail.com. Purchased for approximately $10K. Asking $5,500/obo.

Graduating dental student seeking associate position in Grand Rapids or surrounding areas beginning in early June. Among the top performers of graduating class and eager to bring strong work ethic, collaborative nature and attention to detail to your practice.

Business-minded professional and committed to providing exceptional dental care. Please contact Katelyn Van Slyke at vanskate@umich.edu or 616.540.6369.

Dental Dreams desires motivated, quality-oriented associate dentists for its offices in Muskegon, Saginaw and Flint. We focus on providing the entire family superior quality dentistry in a modern technologically advanced setting with experienced support staff.

Because we understand the tremendous value of our associate dentists, we ensure that their compensation package is amongst the best. Our average colleague dentist earns on average $230,000 per year plus benefits.

Please contact Danielle Tharp at 313.274.4524 or email dtharp@kosservices.com.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

ADVERTISER INDEX The Bulletin wishes to thank our valued advertisers who support organized dentistry by helping to defray the cost of printing and mailing.

Advertising in the Bulletin is seen by over 90% of the dentists in the West Michigan District. This includes five of the fastest growing counties in the state: Kent, Ottawa, Ionia, Montcalm and Mecosta.

For information on advertising rates, call Elaine Fleming, WMDDS Executive Secretary at 234-5605. Target your Market – advertise in the Bulletin!

Beene Garter.......................................14 DDS Integration..... outside back cover Davis Dental Laboratory................ inside front cover Founders Bank & Trust.....................21 Great Lakes Financial Insurance.......17 Henry Schein.............inside back cover Hungerford, Aldrin, Nichols & Carter, PC...........................................18 Keystone Pharmacy...........................14 MDA IFG............................................11 ProAssurance.....................................13

23

What is My Practice Worth?

Lunch & Learn with Hungerford Valuation 1.

2.

3.

4.

Are you an associate with plans to buy a practice?

Will you use the sale of your practice to fund your retirement?

Do you have an exit strategy or succession plan?

Have you considered bringing in an associate?

Practice valuation is more than just a rule of thumb. Hungerford Valuation will present an overview of dental practice valuation techniques. We will explore why practice value is important as well as how practices are valued. Participants will leave with an understanding of basic valuation concepts and tips you can use to improve the value of your practice.

Please join Kerry A. Bean, CPA/ABV and Brandon Finnie of Hungerford Valuation for this free informative session. Kerry and Brandon have valued hundreds of privately-held businesses including dental practices.

Topics of discussion will include: Why It’s Important to Understand Your Practice’s Value • Succession Planning • Buy/Sell Purposes Practice Valuation Overview Tips to Improve Your Practice’s Value When:

Friday, April 19th, 11:30 a.m. to 1:00 p.m.

Agenda:

11:30-12:00 p.m. Registration and Lunch 12:00-1:00 p.m. Presentation

Where:

Hungerford, Aldrin, Nichols & Carter, PC – Cripps Training Room 2910 Lucerne Drive SE Grand Rapids, MI 49546 Register now by calling Sharon Whipple at HANC 616-949-3200 or via email at swhipple@hanc.com. Reservations are required.

24

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013

3M is boldly redefining the economics of CAD/CAM dentistry Introducing...

True Definition Scanner Now CAD/CAM dentistry is within reach for any practice.

• Predictable clinical outcomes • Open, secure cloud-based platform • Consistently accurate • Reliable • Affordable — $11,995 Suggested Retail Price with data plans starting at $199 per month

SSee ee why why iit’s t’ss ttime ime ttoo go go digital digital w with ith 3M 3M aatt www.3M.com/TrueDef www.33M.ccom/TrueDef Call 616-791-2358 and ask for our Technology Specialist 3M is a trademark of 3M or 3M Deutschland GmbH. Used under license in Canada. ©3M 2013. All rights reserved. Please recycle. Printed in U.S.A.

WEST MICHIGAN DENTAL SOCIETY 511-F Waters Building Grand Rapids, MI 49503

PRSRT STD US POSTAGE PAID GRAND RAPIDS, MI PERMIT # 657