mmentorA practical guide for the advancing dentist
In this issue:
HOW TOPUT INSURANCE TO WORK in Your Practice
IMPLANT DENTISTRY for the Recent
Dental Graduate
HOW TO
CREATE A BUDGETfor Your Dental Business
Dear Reader,
This is my favorite time of year! In Colorado, we get to do some spring ski-ing. I’m anxiously waiting to watching the University of North Carolina win theNCAA basketball tournament. Some of my favorite national dental meetings arecoming up, and this year is even more special because we have added an associ-ate to our practice.
For many of you, this spring marks the huge milestone of graduation! Yearsof hard work will now culminate in your joining the fraternity of practicing den-tists. For others of you, it means there is light at the end of the tunnel as anotheracademic year comes to a close.
In this issue we’ve tried to bring to you some information that will be imme-diately helpful as you begin in your careers beyond dental school. It’s never tooearly to begin to understand budgeting for a dental practice (even if you don’town one yet…..someday you probably will). Insurance is an important subject tobe well versed in, and we’ve provide you with some good basic information here.Understanding and developing a game plan for incorporation of technology intoa dental practice is important for improving patient care as well as your enjoy-ment of practice. In this issue, we’ve tried to help you make smart decisions.
Clinically we’ve brought in 2 subjects that are of emerging interest and impor-tance. Invisalign has revolutionized orthodontic treatment and who receives it.Although it will never replace conventional orthodontics, it is a wonderful tool tohelp patients improve their smile. Lastly, my good friend Dr. Aldo Leopardi haspresented some words of wisdom on implants, which provides great advice tohelp you be more successful with your implant cases.
Lastly, I’d like to thank all of you. As I get e-mails after each issue, it becomesmore and more apparent to me that we are providing information to you that youfind helpful and informative. Please continue to give us feedback so we can con-tinue to evolve and improve this journal.
Sincerely,
Gary M. Radz, DDSEditor-in-Chief
MENTOR | Letter From the Editor
Gary M. Radz, DDSDr. Radz maintains an esthetic-
based general practice inDenver, Colorado. He serves onthe editorial board of 7 different
journals, and is a sustainingmember of the American
Academy of Cosmetic Dentistry.Along with an international
speaking schedule, Dr. Radz hasbeen an associate instructor for4 different postgraduate educa-
tional institutions and currently isan associate clinical professor at
the University of ColoradoSchool of Dentistry. He received
his fellowship from the Academyof Comprehensive Esthetics andalso volunteers as a member ofits advisory board. Locally, Dr.Radz served for 3 years as the
public relations chairman for theMetro Denver Dental Society and
is serving his third year on theContinuing Education Committee.
He welcomes questions or com-ments at 303-298-0182 or
Daniel W. Boston, DMDTemple University
Frank A. Catalanotto, DMDUniversity of Florida
Cherae Farmer-Dixon, DDS, MSPHMeharry Medical College
Marc Geisberger, DDS, MAUniversity of the Pacific
James J. Koelbl, DDS, MS, MJWest Virginia University
Howard M. Landesman, DDS, MEdUniversity of Colorado
Lawrence Levin, DDSNOVA Southeastern University
Denis P. Lynch, DDS, PhDMarquette University
Frank E. Pink, DDS, MSUniversity of Detroit Mercy
James F. Simon, DDS, MEdUniversity of Tennessee
Harold C. Slavkin, DDSUniversity of Southern California
Martin F. Tansy, PhDTemple University
Mentor Executive Committee
4 Mentor
MENTOR | Advisory Board
mentorsLawrence Caplin, DMD, CCHPDr. Caplin is the founder and CEO of Dentrust Dental International, a provider of dental care forfederal, state, and local governmental agencies throughout the United States. He is also the founderand CEO of National Dental Company, a professional services organization assisting dentists in re-cruitment, practice design and construction, and the transition from education into practice. Hesits on several boards of directors for nonprofit dental and health clinics. He welcomes questions orcomments at 888-876-6372 or [email protected].
John Gammichia, DMDDr. Gammichia is a partner in a general dentistry practice with his father in Orlando, Florida. Heholds a part-time faculty position for the University of Florida AEGD Program, working with first-year residents. He also has held a part-time faculty position at an outreach facility for the Universityof Florida overseeing senior dental students. He gives a presentation to dental conferences and den-tal societies titled, “What You Need to Know About the First Five Years of Practice.” He welcomesquestions or comments at 407-889-4868 or [email protected].
Charles D. Samaras, DMDDr. Samaras graduated from Farleigh Dickinson University in 1975 and Tufts University School ofDental Medicine in 1982. He has been a general restorative dentist since 1982 at his practice inLowell, Massachusetts, and is the director of practice management at Tufts. Dr. Samaras hasauthored numerous articles and lectures nationally and internationally on dental technology. He isa member of the American Dental Association, the American Academy of Cosmetic Dentistry, theAcademy of Implant Dentistry, and the Academy of Laser Dentistry. He welcomes questions orcomments at [email protected].
Roger D. Winland, DDS, MS, MAGDA graduate of Ohio State University (DDS), Dr. Winland received his Academy of General Dentistry(AGD) fellowship in 1984 and his mastership in 1991. He is also a fellow of the InternationalCollege of Dentists, the Academy of Dentistry International, and the American College of Dentists.Dr. Winland is a delegate for the Ohio Dental Association and sits on the Ohio Dental AssociationTask Force on Managed Care. He is a past president of the Ohio AGD and the Hocking Valley DentalSociety. He has a general dentistry practice in Athens, Ohio.
D. Walter Cohen, DDSDr. Cohen has been the editor-in-chief of The Compendium for 26 years. He is chancellor emeritus ofMCP Hahnemann University of the Health Sciences and dean emeritus and professor of periodonticsat the University of Pennsylvania in Philadelphia. In 1996, he was honored by the Alpha OmegaFraternity and an annex was built and dedicated to him at the Hebrew University–Hadassah Schoolof Dental Medicine in Jerusalem.
Mart G. McClellan, DDS, MSDr. McClellan is a board-certified orthodontist practicing near Chicago, Illinois. He received his dental train-ing at Northwestern University and his MS in orthodontics from the University of Michigan. He is also thepresident of Financial Clarity, a personal financial planning firm for health professionals, and has lecturedto numerous dental schools, hospitals, and study clubs on personal finance. Dr. McClellan is the author ofBrace$avers, a book offering practical advice to patients and their families on affording braces through cre-ative financial planning. He welcomes questions or comments at 800-281-0703 or [email protected].
5April 2007
Contributors | MENTOR
Contributors
Aldo Leopardi, BDS, DDS, MSDr. Leopardi received his dental training from the University of Adelaide, South Australia, andUniversity of Detroit Mercy (UDM), Michigan. In 1993, he received his specialist training and mas-ter’s degree in combined fixed, removable, and implant prosthodontics at the University of NorthCarolina, Chapel Hill (UCH-CH). He was faculty at UNC-CH, UDM, and Colorado Health SciencesSchool of Dentistry. Since 1999, he has been in full-time private practice limited to prosthodonticsin Denver. Today, he lectures nationally on fixed, removable, and implant dentistry and is involvedin clinical research. He is also the founder and president of the Denver Implant Study Club.
Christina T. Do, DDSDr. Do is a 2003 Loma Linda University graduate. She is an active leader in the field of laser den-tistry and has lectured extensively around the United States on trends in laser dentistry. Dr. Dopractices in a private dental office which incorporates Invisalign, lasers, digital imaging, andother new developments in dentistry. She is a member of the American Dental Association,California Dental Association, Orange County Dental Society, World Clinical Laser Institute, andthe Business Intelligence Task Force.
David A. Little, DDSDr. Little is a graduate of the University of Texas Health Science Center dental school in SanAntonio, Texas (UTHSCSA). He specializes in esthetic and full-mouth restorations, including dentalimplants. In addition to serving as an adjunct professor at UTHSCSA dental school, he is a fellow in the International and American Colleges of Dentistry and a member of the American DentalAssociation, Texas Dental Association, American Academy of Cosmetic Dentistry, and Academy of General Dentistry. Besides his practice, Dr. Little is cofounder of Dental Team Concepts andDynamic Dental Graphics.
Randa O’ConnorMs. O’Connor is president of Pinnacle Practices, Inc (www.pinnaclepractices.com), a dental practicemanagement firm founded in 1987 and headquartered in Dallas, Tex. Pinnacle Practices has grownto serve more than 1,200 dental teams under Randa’s vision and leadership. Randa’s ability to moti-vate and empower people to take ownership for their personal success is what makes her a greatspeaker and leader in the dental industry. She can be reached at [email protected].
Jim BiesterfeldJim Biesterfelt is Vice President of Group Special Accounts at Great-West Life & AnnuityInsurance Company. Great-West underwrites and administers the American Dental Association(ADA) Insurance Plans and is the exclusive provider of ADA-sponsored life and disability insur-ance to ADA members and their families. For more information call 888-463-4545 or go towww.insurance.ada.org.
Daniel J. Carlson, DDSDr. Carlson owns Birchwood Dental, a cosmetic family practice in Eagan, Minnesota. Before receiv-ing a doctoral degree from the University of Minnesota (1998), he earned a bachelor’s degree in psychology from the University of St. Thomas in St. Paul. Dr. Carlson is a member of the St. PaulDistrict Dental Society, the Minnesota Dental Association, and the American Dental Association. Inaddition to completing courses in Lumineers placement and Invisalign Certification I, Dr. Carlsonwas listed among the “Top Dentists” in the Twin Cities metropolitan area by Mpls. St. Paul Magazine(2005). He welcomes comments at [email protected] or 651-994-1700.
Jim Poole, MBAMr. Poole is a managing partner at Focused Evolution, Inc, a marketing strategy/general manage-ment consulting firm focused on the dental industry. They specialize in growth strategies includinglaunch planning and execution of start-ups, products, and services. He can be reached [email protected].
MENTOR | Table of Contents
Professional DevelopmentAdvisory Board 4
How to Create a Budget for Your Dental Business8 Jim Poole, MBA; David A. Little, DDS; Randa O’Connor
How to Put Insurance to Work in Your Prractice 8 Jim Biesterfelt
Features Digital Technology in the Startup Practice 16 Daniel J. Carlson, DDS
Marketplace 20
DepartmentsSee Through Success with Invisalign 22 Christina T. Do, DDS
Implant Dentistry for the Recent Dental Graduate26 Aldo Leopardi, BDS, DDS, MS
Sponsor Page 32 Back Cover
President, Healthcare Division Director, Business Operations Publisher Sales & Marketing CoordinatorWill Passano Healthcare Division David Branch Deborah Thalor
Leila Davis
Projects Editor Director of Quality Assurance Circulation DirectorLara J. Reiman Barbara Marino Thomas Lorge
Projects Director Director, Manufacturing and Production Design Director, Advertising ManagerSusan M. Carr Elizabeth Lang Wayne Williams James Marshall
Ascend Media Corporate Officers:
President & CEO Executive Vice President Executive Vice President, Senior Vice PresidentCameron Bishop & COO Sales & Marketing & CFO
Dan Altman Ron Wall Mark Brockelman
WARNING: Reading an article in Mentor does not necessarily qualify you to integrate new techniques or procedures into your practice. Mentor expects its readers to rely on their judgment regarding theirclinical expertise and recommends further education when necessary before trying to implement any new procedure.
Copyright © 2007 Ascend Media. All rights reserved. The Compendium is a registered trademark of Ascend Media, with editorial, executive, and advertising offices at 103 College Road East, Princeton, NJ 08540.Phone: 609-524-9500. Fax: 609-524-9658. Periodicals postage paid at Shawnee Mission, KS Post Office and at additional offices. No part of this issue may be reproduced in any form without written permissionfrom the publisher. Compendium is published monthly. Printed in the United States of America. D575
6 Mentor
mc o n t e n t smentor
8
MENTOR | How to Create A Budget for Your Dental Business
HOW TOCreate A Budgetfor Your Dental Business
Jim Poole, MBA; David A. Little, DDS; Randa O’Connor
Mentor
MENTOR | How to Create A Budget for Your Dental Business
9
Helping people through dentistry is a noble endeav-or. In addition to helping people, you are probablyworking hard to build a financially secure future. In ourFebruary article, entitled “How to Write A BusinessPlan,” we addressed the need for a plan to achieve yourpersonal and professional goals. To execute your busi-ness plan you need to understand your businessfinances and how to create cash flow. A budget canprovide the guidance and discipline necessary to moni-tor your progress and to identify your successes.
There are 3 financial documents you should useregularly to manage your business: an income state-ment, a balance sheet, and a cash flow statement. Werecommend that you gain an understanding of theseconcepts and employ a trusted accountant who is famil-iar with dental businesses to manage these metrics. Youwork hard. We want you to reap the rewards of yourhard work by letting others aid you in their fields ofexpertise. Remember, what gets measured gets done.
An income statement is a summary and trackingtool of your production (revenue) and your expenses.Some people call an income statement a P and L forprofit and loss. The term you use is not important, butthe concept and act of creating and monitoring yourbudget is pivotal to understanding the key drivers toyour business success. You can create your budgetbased on the previous year’s experience and outcomescombined with your desired growth for the year. Wehave added industry benchmarks for your reference. Itis important to break down your budget into quartersand to track the outcomes. Measuring and understand-ing the variance between your expected budget andactual dollars is the information you need to makemanagerial decisions and continuous improvements toyour dental business. You don’t want to wait an entireyear before realizing you have major problems thatcould have been already identified and addressed.
April 2007
Creating an operating budget for your dental
business may not sound like fun, nor is it the
reason you chose to go to dental school. However,
financial metrics serve many purposes that can
benefit your personal and professional life: as a
guidance tool to understand how your business is
growing/declining; for visibility into what part of
your business requires attention; to predict your
income; and to reduce the risk of embezzlement.
Ignorance is not bliss when it comes to operating
a business and handling your cash.
10 Mentor
“Checking the results of a decisionagainst its expectations shows executiveswhat their strengths are, where they needto improve, and where they lack knowl-
edge or information.”—Peter Drucker
Income StatementThe itemized expenses below should be categorized
into the following: quarterly budget, quarterly actual,quarterly variance, annual budget, annual actual, andannual variance.
Benchmark Clinic operating days1. Production
• Operative• Hygiene• Write-offs
20%-25% 2. Salaries and compensation5%-10% 3. Employee benefits
• Payroll taxes• Health insurance• Life insurance• Retirement plans• Automobile expenses• Car allowances• Other
2% 4. Travel and conferences• Airfare• Hotel and lodging• Conferences and seminars• Meals• Car rentals• Office meetings• Other
5% 5. Office occupancy• Rent• Utilities• Depreciation• Taxes and licenses• Other
5% 6. Office operations• Telephone and answering service• Stationery, brochures, business
cards, etc.
• Office supplies• Bank charges• Liability insurance• Furniture rental and depreciation• Repairs, maintenance, and
cleaning• Computer operations• Dues and subscriptions• Postage and freight• Laundry and uniforms• Plant service• Other
1%-5% 7. Marketing and promotions• Advertising• Publicity and promotions• Other
1%-2% 8. Collection expenses• Collection agency expenses• Recording fees• Audit reports• Credit card expenses• Interest expenses• Loan servicing fees
2%-5% 9. Professional services• Legal• Accounting• Auditing• Outside consulting• Outside computer services• Contract labor• Professional fees• Other
8%-12% 10. Laboratory fees6%-9% 11. Dental and hygiene supplies2%-4% 12. Miscellaneous expenses57%-84% 13. Total expenses before doctor’s
salary14. Doctor salary15. Total operational expenses16. Contribution to net profit17. Profit paid (Profit pay should be
paid quarterly but accruedmonthly, based on the practicemeeting its profit goals.)
18. Net profit (loss)
MENTOR | How to Create A Budget for Your Dental Business
11April 2007
A balance sheet is a financial statement that pro-vides a snapshot of your dental businesses’ assets andliabilities. It is called a balance sheet because assets =liabilities + owner’s equity. For the purpose of this arti-cle, we are going to focus on current assets and liabili-ties as they provide insight into your working capitaland cash flow. The key to success is managing yourcurrent assets and liabilities effectively and efficiently.Implementing systems to understand and manageaccounts receivable, collections, inventory, andaccounts payable can reduce the stress of daily opera-tions. We want you to focus on dentistry and patientsatisfaction, not on how to stretch every dollar andmake payroll next week.
Your current assets consist of cash and accountsreceivables. Billing and collecting accounts receivablesare major sources of stress in the dental industry. Thegoal is to collect your money effectively and efficiently.You presumably did not go to dental school to serve asa community lending institution. Collecting moneyfrom patients and insurance companies is not easy, andtoo often dentists take a loss for services rendered. Thefinancial/insurance policies that you offer to yourpatients are your choice. We recommend that youdevelop and communicate your financial policies fre-quently and consistently to avoid confusion.
Balance Sheet 3/31/071. Current assets
Accounts receivableCashInventory
2. Current liabilitiesLine of creditAccounts payableTaxes
Cash flow statements are arguably the most impor-tant financial statement to track, because for smallbusinesses “cash is king.” Cash flow statements areunique from income statements and balance sheetsbecause they specifically look at cash, not credit. Yourcash flow is correlated to how you run your business:
patient base, new patient growth, patient satisfaction,patient recall and adherence, case acceptance, staffturnover, technology investments, accounts receivable,collections, inventory management, accounts payable,rent, equipment, etc. The cash flow statement may beused as an indicator of financial health. Strong positivecash flow (in particular, cash flow from operations)usually indicates exceptional performance. You may usethis statement to create future budgets and to determinethe optimum timing of significant investments.
Cash Flow 3/31/071. Operating
Over-the-counter collectionsInsurance collectionsAdd back of depreciationChange in working capital
2. InvestingCapital expenditures
3. FinancingCash from loansDividends/profit paid
Cash flow from Quarter 1 of 2007
“The future you see is the future
you get.”—Robert G. Allen
We understand that being a dentist means wearingmany hats: practicing the art of dentistry, managingpatient expectations and satisfaction, leading and man-aging a dental team, and managing the daily operationsof a small business. Understanding cash flow and thefinancial health of your business is an important aspectof your career choice and should not be ignored. Wehope you have gained a basic understanding of anincome statement, balance sheet, and cash flow state-ment. Please take the time to find and employ a talent-ed accountant who is experienced in the dental industryto guide and manage your business finances. Yourfuture depends on it. Good luck and please contact usif we can be of further assistance to you. n
12 Mentor
If you’re just getting your professional career under-way, you may think of life and disability insurance assomething you should have in case the unthinkable
happens—you become disabled from an accident or ill-ness or die prematurely. You naturally hope neither willhappen, but preparing for the worst is the wise thing todo. But you don’t have to become disabled or die to ben-efit from life and disability insurance. In fact, these prod-ucts can be valuable business tools for you right now.
Both types of insurance have 2 important businessuses: as collateral for a practice loan and to fund abusiness succession plan. To illustrate how you can takeadvantage of these very practical uses for insurance,we’ll look at 2 new dentists, Kathy Pawlusiewicz, DDS,in Mount Prospect, Illinois, and Timothy Seidenstricker,DDS, in Chico, California.
Guaranteeing a LoanIf your plans include purchasing a practice or start-
ing one from scratch, you will probably need to obtaina sizeable loan. When applying for that loan, the lendertypically will ask for a guarantee that the debt will be
MENTOR | How to Put Insurance to Work in Your Practice
Jim Biesterfelt
HOW TO Put Insurance toWork in Your Practice
13April 2007
paid if you die or become disabled before it’s fully re-paid. This guarantee is called collateral.
In our experience at Great-West, loan collateral is acommon use for life and disability insurance amongnew dentists. That was the case with Dr. Pawlusiewicz,who had the opportunity to purchase Prospect Dental,the practice she had entered as an associate. “Theowner wanted to sell, offered it to me, and I jumped atthe chance,” she says. A practice broker who represent-ed the owner referred Dr. Pawlusiewicz to a lender tofinance the loan she needed. “The lender told me thatthe only collateral they would accept was life and dis-ability insurance,” the 30-year-old dentist recalls.
Because Dr. Pawlusiewicz is a member of theAmerican Dental Association (ADA), she applied forinsurance through Great-West Life & Annuity Insur-ance Company, which underwrites and administers theADA-sponsored group life and disability insuranceplans. She purchased a life insurance policy to cover theamount of the loan, and temporarily assigned the poli-cy to the lender as collateral. That way, if she were todie before the loan is paid off, the lender would bereimbursed out of the policy’s proceeds for the amountowed, and the balance of the insurance would go to herdesignated beneficiary.
Dr. Pawlusiewicz also applied for business over-head expense insurance—a very affordable type of dis-ability insurance—to cover her monthly loan paymentsif she were to become disabled while paying off theloan. Again, the policy was temporarily assigned to thelender as collateral.
As soon as Dr. Pawlusiewicz’s coverage wasapproved, Great-West provided her with collateralassignment forms to sign and return. Then, recordedcopies of the forms were forwarded to the lender, andthe sale closed.
Dr. Pawlusiewicz took out a 7-year loan. As soonas she pays it off, she plans to notify Great-West, whichwill then remove the collateral assignment from thepolicy. At that point, she will be free to use the insur-ance for any other personal or business purpose shewishes.
Insuring a Succession PlanDr. Pawlusiewicz worked through a third-party
lender to buy her practice. Dr. Seidenstricker set up
things a little differently, but the result is the same: hewill eventually own a practice. “Soon after I graduated,I had the opportunity to buy into a practice owned byMichael Lim, who is now my partner,” Dr. Seiden-stricker, age 29, says. “Dr. Lim is 59, and when heretires, I will take over the practice.”
The 2 dentists agreed that Dr. Lim would carry theloan Dr. Seidenstricker needed to buy into the practice.In addition, the dentists negotiated a business succes-sion plan and purchased life and disability insurance tofund the plan. (This type of business succession plan isoften referred to as a buy–sell agreement.)
With the life insurance, each dentist is the designat-ed beneficiary on the other’s policy. That way, if Dr.Seidenstricker were to die while in debt to his partner,the life insurance proceeds would go to Dr. Lim to payoff the loan. If Dr. Lim dies first, the life insurancewould be paid to Dr. Seidenstricker, who would thenhave the money needed to buy Dr. Lim’s share of thepractice from his estate.
In addition, business overhead expense policiespurchased on behalf of each partner will help keep the
14 Mentor
practice running if either one becomes disabled. Thistype of insurance reimburses a disabled dentist for cov-ered overhead expenses, such as rent or mortgage pay-ments, utilities, employee salaries, etc. “It’s a safety netfor each partner,” Dr. Seidenstricker says. For both thelife and disability insurance, the practice pays the pre-miums as a business expense.
Sole practitioners also can use insurance in a busi-ness succession plan. To illustrate, let’s use a hypotheti-cal solo dentist, Dr. R, who prearranges a buy–sellagreement with a colleague. The agreement stipulatesthat in the event of Dr. R’s death, the practice must bepurchased by the colleague from Dr. R’s estate. Insur-ance on Dr. R’s life, made payable to the buyer, guaran-tees that funds will be available to carry out the agree-ment.
Similarly, business overhead insurance can providefunds to help cover a sole practitioner’s monthly oper-ating costs while the dentist either recovers from thedisability or makes plans to sell the practice if the dis-ability is permanent. Without proper insurance in place,a solo dentist could be forced to use personal funds tokeep the practice operating while disabled.
Tips from ExperienceHaving successfully navigated the acquisition of
their practices, Dr. Seidenstricker and Dr. Pawlusiewiczshare these 3 tips for other new dentists who dream ofbusiness ownership:
• Explore your financing needs and requirementswell in advance. Learn what lenders typically requireand when you will need to provide it.
• Get your insurance early. Consider obtaining the
insurance you may need long before you apply for apractice loan. That way, the insurance will be in place,and you can move quickly to close the sale.
• Assemble a team to help you. Surround yourselfwith experienced professionals who can provide guid-ance, advice, and mentoring. The team might include apractice broker, financing firm, insurance company rep-resentative, accountant, and attorney. Keep a dailychecklist of people to call and things to do.
To learn more about the business uses of life anddisability insurance, visit the new dentist’s section of theADA Insurance Plans’ Web site at www.insurance.ada.org/newdentist, or call 888-463-4545. n
Editor’s note: This article does not constitute legal, tax, or financial
advice. Please seek professional input as appropriate to your situation.
For more information on the ADA Term Life Plan (Group
Policy #104TLP) and the ADA Office Overhead Expense Plan
(Group Policy #1106GDH-OEP), call 888-463-4545 or go to
www.insurance.ada.org.
MENTOR | How to Put Insurance to Work in Your Practice
“The lender told me that the
only collateral they would accept
was life and disability insurance.”
—Kathy Pawlusiewicz, DDS
Two Business Uses for Personal InsuranceCollateral Assignment
What is it? The temporary assignment of aninsurance policy to a bank or other creditor assecurity for a loan.
How does it work? If the insured dentist is dis-abled or dies before the loan is repaid, the creditoris entitled to be reimbursed out of the insurancepolicy’s proceeds for the amount owed.
Buy–Sell AgreementWhat is it? A legally binding agreement that
outlines a succession plan for a business.How does it work? Typically, the agreement
states that the business interest of an owner whodies or is permanently disabled must be sold to,and will be purchased by, the remaining co-ownersor another predetermined entity for an agreed-onprice. Insurance is often used to provide the fundsto carry out the agreement.
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16 Mentor
MENTOR | Digital Technology in the Startup Practice
As patients become progressively more educatedand engaged in their care, digital technologieswill continue to play a meaningful role in the
practice—allowing patients to accurately see and under-stand the status of their oral health, participate in codi-agnosing their conditions, and assist in formulating atreatment plan.
But, where to start when you’re just beginning?Although integrating digital technologies into yourpractice may seem like a daunting and unmanageabletask, starting a new practice is the ideal time to incor-
porate digital technologies. Most technologies todayhave a manageable learning curve, in addition to train-ing and support options. In fact, purchasing and imple-menting digital technologies can be an exciting learningexperience. Plus, the time and effort you and your staffspend learning to use digital technology is easily out-weighed by the ease and efficiency it brings to yourpractice. As your comfort level with digital tools rises,your practice will naturally become more efficient witheach passing day.
When building our cosmetic family practice, we
Daniel J. Carlson, DDS
Digital Technologyin the Startup Practice
17April 2007
wanted every piece of equipment to be top of the line—and that meant going digital. This article will discusssome important points to consider when incorporatingdigital technology into a startup practice.
Strategic PlanningEquipping a digital startup is exciting! You have
the freedom and flexibility to choose exactly what tech-nologies will go into your practice. Conversely, youinherit the time-consuming responsibility of researchingand deciding which types of equipment you willinclude. In addition to the cost of the equipment, youalso must consider the time and effort required of yourstaff to become familiar with the equipment. As such, astrategic technology plan can help you systematicallybuild up your practice.
When starting our practice, we approached theimplementation of digital technology slowly and sys-tematically. As an accountant, my wife provided herexpertise in regard to finances, and together we devel-oped a business plan that assessed the costs of theequipment we wanted to incorporate. We brought ourbusiness plan to the bank, outlined our ideas for them,and successfully sold the bank on our idea. Equippedwith the financial means to begin building the practice,we put our energy toward investigating exactly whatthat would entail.
I met with several local doctors who had recentlystarted new practices and toured their offices, taking noteof my likes and dislikes, and asked them to divulge someof the initial challenges and questions they had faced.Each doctor reiterated that going digital requires a com-mitment of time, money, and hard work, but the returnon investment is well worth it. In addition, I learned thatthe high-performing digital practice relies not solely oneach individual piece of equipment, but on how theycomplement each other and function in tandem.
Components of Digital IntegrationThe first piece of digital technology to consider
when starting a practice is clinical and practice manage-ment software. Personally, I pictured our practice as apaperless office and knew that the software was amust-have. We selected Patterson EagleSoft practicemanagement and clinical software, knowing their repu-tation for top-notch service and support. To learn the
system, we went through 4 days of onsite training, andwith the help and flexibility of Patterson’s support, wewere able to see patients during 2 of these days.
The effective use of practice management and clini-cal software can greatly enhance customer serviceefforts. Patient records are stored within a single data-base in Patterson EagleSoft, allowing all staff membersto access records and images instantaneously from anycomputer in the practice. Digital photography is anoth-er invaluable resource for any practice. We installed aLogitech webcam in the front office and reception areato monitor activities and alert us to patients enteringand leaving the practice. For digital photos, we chosethe Canon G6 PowerShot 7.1-megapixel digital camera.This camera fulfills the American Academy of CosmeticDentistry requirements and is specifically designed totake the variety of shots dentists need.
Digital operatories were also a priority in the visionof my practice. Digital radiography became part of that,specifically Schick digital x-ray sensors and equipment.With Patterson EagleSoft, digital radiographs are inte-grated seamlessly into patient records, and the AdvancedImaging feature makes it easy to acquire, save, and editdigital x-rays. Additionally, the Planmeca digitalpanoramic x-ray machine provides high-quality imagesinstantly, and has proved especially helpful for full-mouth and orthodontic cases. Intraoral cameras werealso installed in all of the operatories. The Acclaim intra-oral camera (Air Techniques) provides images quicklyand efficiently. Once you insert the wand and push thebutton, you are ready to take multiple pictures through-out the appointment.
My staff and I have found patient acceptance andinterest in this technology to be overwhelming. Addi-tionally, we installed 17-inch computer monitors infront of and behind the chairs in the operatories. Thisconvenient setup permits patients to easily see issues upclose, allowing them to better understand problems. Theavailability of digital pictures at the click of a buttonmakes it simple to get patients involved. This “wow”factor has sparked conversations with patients regardingdiagnosis and treatment, clearly encouraging them toassume a proactive role in their care.
Another digital technology that we chose to imple-ment is CEREC. This piece of equipment was one ofour most expensive investments, but it truly played into
the entire vision of a digital practice described in ourbusiness plan. We viewed it as something that wouldset our practice apart from others, as well as an invest-ment in the future of the practice and continuing educa-tion for the staff. We also wanted every patient’s firstimpression of our practice to be admiration of ourhigh-tech methods, and CEREC most certainly con-tributes to that goal. The ease and precision of thismachine is truly remarkable, and patient response tothis technology has been very positive.
Positive ResultsThe greatest result of implementing both extraoral
and intraoral digital imaging has been its usefulness inaugmenting patient education and garnering thepatient’s involvement in his or her treatment. Theimages facilitate conversation, instigating patients’questions and, in some instances, identifying the prob-lems themselves. As I, or a member of my staff, de-scribe a condition, the patient can view his or hermouth closely on a screen and ask questions, subse-quently deepening their comprehension of the problem.It also adds to our practice’s overall efficiency by savingtime. By the time I arrive in the operatory, the patient isprepped physically and mentally, and I take care ofdescribing treatment options and discussing esthetics.Additionally, these images can then be printed as take-home materials. For example, we have provided beforeand after shots to patients undergoing whitening treat-ments. The patients love comparing the before image
with the after image. Before, during, and after shotsalso are useful in showing bone loss or detecting cavi-ties, because users can zoom in on a small area andchange the contrast, making issues more apparent.
As a result of incorporating the aforementionedtechnologies and using them effectively, my staff and Ihave seen great growth since opening our doors in2005. We began seeing patients 2 days per week andhave now increased to 4 days per week. Recently, webegan booking appointments into the next month. Weare far ahead of where we projected to be in terms ofpatient numbers and have reached a point where weneed to add to our staff of 5. We continue to set goalsand examine the functionality of digital equipment inour practice, continually adding to the technology weuse now. We currently have 3 fully-equipped digitaloperatories and have room to grow into a fourth.However, as we expand and have less time to talk withpatients, we anticipate that patient education software,such as CAESY Enterprise (CAESY EducationSystems), in the operatories and reception area will beour next digital technology purchase.
The Bottom LineDigital technology provides an efficient way to treat
patients. Equipping your practice with top-of-the-linedigital technologies creates a user-centered business andpatient-centered experience, creating the ideal situationfor your practice to grow and your patients to receivethe best possible care. The following tips may assist you
MENTOR | Digital Technology in the Startup Practice
Mentor18
19April 2007
in the process of implementing digital equipment:Begin by assessing your needs. What technologies
do you need to ensure high-quality performance in yourpractice? Which will increase your efficiency? Whichmake the most sense for your practice?
Prioritize by differentiating between your wantsand needs. Are there pieces of equipment you or yourstaff would like, but probably aren’t necessary at thistime? Consider putting those items on a wish list to dis-cuss and prioritize with your staff. As financialresources allow, gradually implement these items.
Plan ahead. Perhaps those items on your wish listare part of a long-term plan. For instance, we equippedthe reception area with the capabilities and wiring forflat screen televisions, so that it will be ready when thetime comes to add patient education videos or CAESYSmile Channel (CAESY Education Systems) to thereception area.
Be flexible. Allow yourself an extended period oftime to research the equipment before you buy. Giveyourself the luxury of exploring your options so thatyou can make an educated decision. Take advantage ofproduct demonstrations and ask questions to see if theproduct can be tailored to your individual needs. Forexample, when we were first introduced to PattersonEagleSoft clinical and practice management software,the representative took the time to demonstrate the mul-
titude of ways that the tools can be customized to meetour practice’s specific requirements.
Think realistically. Consider the training time andthe learning curve that each piece of technology willpresent to your office. As you begin implementing tech-nologies, avoid burnout by scheduling training sessionsintermittently. Allow time after each to not only reviewwhat you have learned, but to test the equipment.
Think positive. Incorporating digital technologyinto your practice, especially multiple pieces of equip-ment at a time, is a big undertaking. Do not allowstress, frustration, or feelings of doubt about yourcapabilities overcome you. Take the process step bystep, keeping the end goal—a high-efficiency practice—in mind. Holding biweekly meetings with your staff todiscuss issues, share frustrations, and talk about solu-tions can keep everyone from feeling overwhelmed andensure that they feel supported.
Approaching “going digital” from a rational, well-planned perspective will ensure that you are making thebest technology decisions for your practice now andlooking ahead into the future. Prioritize the needs ofyour practice and let your purchasing decisions followsuit. Digital technologies may seem overwhelming atthe start, but once mastered, you will be amazed at theefficiency, reliability, and security they bring to yourpractice. n
20 Mentor
MENTOR | Marketplace
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Check out the insurance that protectsmore than 100,000 dentists, dental students,and their families each year—and that canhelp YOU protect what’s important too. Geta personal consultation at 888-463-4545 or afree quote at www.insurance.ada.org. n
M A R K E T P L A C E
LUMINEERS® BY CERINATE® is the biggest advancement in9,000 years of dentistry. Painless, proven, and patented.Cerinate porcelain, due to its superior properties, can be made as
thin as a contact lens and may be placed without removal of painfultooth structure (only enameloplasty in some cases). PatentedCerinate porcelain allows you to provide your patients with a safer,more esthetic alternative choice to traditional veneers. Cerinateporcelain, exclusively fabricated and manufactured by Cerinate SmileDesign Studios, permanently whitens, reshapes, straightens, andlengthens your patients’ smiles and is backed by 20 years of evi-dence-based research. Without injections or anesthesia, you can com-pletely transform your patients’ smiles!
Consumers are calling in for an extreme makeover in a gentleway. More than 3 million consumers have inquired about LUMI-NEERS! With a 40% increase in media exposure, LUMINEERS arebooming and patients are seeking their community LUMINEERSdentist for new, beautiful smiles!
For more information call 800-445-0345 or visit www.lumi-neersdds.com. n
LUMINEERS—The Alternativeto Traditional Veneers
Where Dentists Get Their Insurance
Consistent with its launch in 1996, www.dental-care.com provides dental education materials, con-
tent, and science to US dental professionals from pre-clinical university studies through dental practice to suc-cessful retirement. With the addition of Oral-B, Crest iscontinuing their ongoing commitment to professionallifelong learning. As a student or dental professional you
will have access to the following:• Free product samples• Continuing education courses• Patient education materials in 15 languages• The Journal of Contemporary Dental Practice• Product information• Practice management information n
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21April 2007
Patterson DentalSupply, Inc provides
the most complete digitalintegration package forall of your practice man-agement, clinical andimaging informationneeds. Direct integrationwith more than 20 differ-ent digital devices fromequipment leaders, suchas Schick, Air Techniques, Soredex, Planmeca, andSirona, eliminates the need for bridges or links to otherproducts, ensuring maximum compatibility, reliability,and performance. With a wide range of digital prod-ucts, practitioners can select the digital devices thatwork best for their practices and rest assured that
those devices integrate seamlessly with PattersonEagleSoft software.
When used in conjunction with PattersonEagleSoft, the process of capturing and storing digitalimages—from intraoral, panoramic, and cephalometricx-rays to intraoral and digital camera images—is sim-ple and efficient. The Advanced Imaging feature inPatterson EagleSoft Version 13.00 allows users tomake image enhancements to highlight specific areasand issues. Storage in a single, secure patient recordprovides the ability to easily acquire images in a cen-tral location and reliably access files from anywhere inthe practice. Using virtually any intraoral camera,video images can be captured and attached to thepatient chart or included in treatment plans to aid inpatient education. For more information, visitwww.eaglesoft.net or call 800-294-8504. n
Pentron Clinical Technologies, LLC is proud to introduce Breeze™
Self-Adhesive Resin Cement, the versatile new self-etch, dual-curecement. Breeze™ Self-Adhesive Resin Cement is formulated withadvanced resin technology to provide the strongest retention availablein a self-adhesive cement with the quick and easy-to-use auto-mixdelivery system. This extremely versatile cement exhibits low expansionproperties ensuring compatibility with porcelains fused with metal,composite, zirconia, alumina, and cementable ceramics.
Breeze™ Self-Adhesive Resin Cement is specifically designed tomake the cementation of crowns, bridges, inlays, onlays, and postsfaster and easier by eliminating individual etching, priming, bonding,and mixing steps. Its efficient auto-mix syringe, with available intra-oral tips for post placement, provides precise, direct, and quick place-ment of cement, even in difficult-to-reach places. The unique formu-lation of Breeze™ Cement enables the dentist to cement and placerestorations quickly and efficiently to minimize chair time while alsovirtually eliminating postoperative sensitivity. Available in 3 versatileshades—A2, translucent, and opaceous white—Breeze™ Cement sup-ports esthetic restorations and provides flexibility with ideal workingand setting times. n
Patterson Technology: Digital Solutions
New Self-adhesive Cement from Pentron Clinical
22 Mentor
See Through Success with InvisalignChristina T. Do, DDS
In a world where an attractive appearance is at
the forefront of everyone’s mind, dentistry has
a role in making this possible. The first thing that
we notice when we meet someone is the feel of
their hand and the look of their face. After this
initial encounter, we begin to break down
the facial features: the eyes, the skin, and, most
importantly, the smile. As dentists, we zone in on
the teeth and smile. Many times we make that first
diagnosis and say, “I can fix his/her teeth
and make them straighter and whiter.”
We believe that every person has a secret wish to
have straight pearly white teeth. But, how can we,
as new dentists, make that happen?
In dental school, we spend countless hours prepar-ing crowns and placing fillings; however, we are onlygiven a few months of orthodontic training. Luckily fornew dentists, with the introduction of Invisalign there isnow the option and opportunity to straighten patients’teeth without spending extra years in school. Invisalign,branded the “clear braces,” is a set of clear trays (align-ers) that the patient changes every 2 to 3 weeks,enabling their teeth to rotate and eventually achievestraight alignment.
After my graduation, I was desperately trying tokeep up with the rigors of seeing patients in a privatepractice. Diagnosis, restoration, patient management,and time constraints were thrown at me all at once.Now that I have gotten into the groove of being in pri-vate practice, I have had the chance to sit back, scratchmy head, and begin to help the patients I was referring.With all the pressures of looking good and having thatstraight smile, I wanted to do something to help mypatients. Catering to a population with orthodonticrelapse and adults who did not like the idea of having“railroad tracks,” Invisalign provides me with theopportunity to address and solve my patients’ needs.
Back to SchoolSo, to give myself another tool in my dental belt
and to offer another service to my patients, I started tolook into how to become an Invisalign dentist.Invisalign offers 2 courses for the general dentist. Thefirst 2-day course is Certification I, which jump startsyour Invisalign career. In this course, I learned aboutthe fundamentals of performing Invisalign cases. Thestaff also learned billing procedures, impression-takingmethods, photography techniques, and the most suc-cessful method of selling the case. Also, I learned how
MENTOR | See Through Success with Invisalign
23April 2007
to diagnose and treat cases thatwould be successful. I learned howto present the case to the patientsand to understand the mechanicsbehind the procedure.
As I sat in class learning thefundamentals of straighteningteeth, I began to feel a new excite-ment for the world of orthodontics.I thought to myself, I can rotate afew teeth, close a few millimeters ofa diastema, and change someone’sprofile. After a full day of informa-tion and a newfound way of treat-ing patients, I returned the next dayto learn the computer program. Ina world of constantly changingtechnology, Invisalign presents itselfat the forefront of the “latest andgreatest.” The second day of thecourse taught me how to rotateimages to visualize patients’ occlu-sion and alignment in a 3-dimen-sional fashion.
Visualization ToolsThe most exciting tool that
Invisalign offers is seeing the antici-pated final outcome of the patient’steeth. The program is set up so thatthe dentist has complete controlover the diagnosis, the rotation ofthe teeth, the change in profile, andthe occlusal preference. The dentistcan also see the exact movement ofthe patient’s teeth every 2 weeksuntil the final outcome.
If the dentist is not satisfiedwith the final outcome, he can keepchanging the way the patient’s teethlook until he is satisfied. Invisalignincorporates attachments, which arecomposite buttons that fasten to theteeth to help with the rotation.Invisalign will also suggest someinterproximal reduction if the
patient needs more space to movethe teeth around. Thus, all thesefactors achieve the orthodontictreatment that we desire. We alllove to be in control and know thefinal outcome before it happens.Invisalign can provide this to a cer-tain extent. I left the seminar know-ing that the way I had been treatingpatients would begin to change.
Incorporating Invisalign into
my diagnosis was very simple. Ibegan treating patients with rotatedteeth who normally would havebeen referred to the orthodontist(Figures 1-6). Patients with ortho-dontic relapse were very gratefulthat they did not have to gothrough the torture of brackets andgingival overgrowth for the secondor even third time.
In my practice, if a patient is
Figure 1—Before Mandibular Figure 2—After Mandibular
Figure 3—Before Mandibular
Figure 5—Before Mandibular Figure 6—After Mandibular
Figure 4—After Mandibular
24 Mentor
interested in Invisalign, their visit is generally a 15-minute consultation. At this visit, I determine thepatient’s reason for wanting Invisalign, the expectationof the patient, and a feel for the patient’s adherence. Alarge portion of successful treatment is patient adher-ence, so choose your patients wisely.
Candidate for SuccessOnce I have determined a patient is an Invisalign
candidate, I then set up another appointment to begintreatment. I typically take study model impressions so Ican begin to formulate a treatment before their nextappointment. Also, before Invisalign, all restorativetreatment needs to be completed.
The first Invisalign visit typically takes about anhour. At this appointment, I take a maxillary andmandibular impression; a bite registration; and 8 photos,which include full face, profile, smile face, occlusal views,side view of teeth, and an anterior view. The patient willalso need to have a full set of x-rays taken or a Panorex.There are special trays for the impressions, but these areall provided by Invisalign. There are a few impressionmaterials that are suggested by Invisalign that will giveyou a better impression outcome.
After this visit, I fill out the treatment sheet with allmy recommendations and send it to Invisalign.Approximately 2 weeks later, I get a computerizedmodel off of the Invisalign Web site. The Web site isvery easy to maneuver and understand; especiallybecause we are a generation that lives on the Internet. Ithen make changes until I am satisfied with the finaloutcome. I typically have my patients come in to viewthe computerized model with me. This computerizedmodel is called the ClinCheck. Once I am satisfied, andthe patient is satisfied as well, I can accept the case
from Invisalign, and at this point they begin to makethe aligners. Three weeks after the acceptance, I get allof the patient’s aligners and a treatment sheet thatstates where I may need to place the attachments orpossibly do some interproximal reduction to createspace for the teeth to move.
This third appointment takes about an hour to placethe attachments, perform some interproximal reduction,and to review the treatment instructions with the patient.
I typically see my patients every 2 weeks or onceper month to check on their progress, provide themwith their next set of aligners, and determine theirmotivational level at that time.
ConclusionThe final outcome of all my Invisalign cases has
been success. The patients are excited, beautified, andhave a new self-confidence. Invisalign has been one ofthe most enjoyable procedures that I have incorporatedinto my dental career. Patients love the simplicity ofchanging their teeth and their look. I love the wayInvisalign is a fun and relatively straightforward proce-dure. I can now cater to another area of concern formy patients.
Patients finish their treatment with a new outlookon the world of dentistry. They no longer hate going tothe dentist, but now say, “Look how my dentistchanged my look and my life.” (Figures 7-9).
Invisalign advertisements are now found every-where. When you flip open InStyle and Glamour maga-zines, there are numerous ads promoting straighterteeth with invisible braces. As dentists, we can providethis esthetic result for our patients and enjoy perform-ing the procedure. Then we can ask ourselves, “Howmuch better can this concept get?” n
MENTOR | See Through Success with Invisalign
Figure 7—Before anterior Figure 8—After anterior Figure 9—Smile after
MENTOR | Implant Dentistry for the Recent Dental Graduate
For the partially edentulouspatient, a significant advantage ofimplant therapy over conventionalfixed crown and bridge dentistry isconservation of tooth structure.The adjacent teeth are left as is.Consequently, oral hygiene andlong-term prognosis of the adjacentstand-alone teeth is enhanced. Also,if adjacent teeth require full cover-age restorations, clinical retrospec-tive studies indicate improved long-term prognosis of teeth with stand-alone crowns versus splintedrestorations (bridge work). Con-sidering the average lifespan of fullcoverage restorations is less than10 years, over the patient’s lifetime,implant therapy is usually morecost effective than conventionalbridge therapy.
For the completely edentulouspatient, implant therapy offersthem retention, stability/security,increased masticatory ability, andimproved psychological well-being(Figures 1-4). Another benefit isbone preservation: dental implantssignificantly slow down boneresorption/loss in the edentulousimplant sites, often arresting itcompletely.
The disadvantages to implanttherapy include additional surgicalprocedures, cost, and time. How-
26 Mentor
Implant Dentistry for theRecent Dental GraduateAldo Leopardi, BDS, DDS, MS
Figure 1—Before anterior Figure 2—After anterior (9 months postop)
Figure 3—Smile before Figure 4—Smile after (9 months postop)
Tooth replacement therapy utilizing root form titanium dental
implants was introduced to North America in 1985. The
acceptance and popularity of this treatment modality among dentists
and the public has since grown. In fact, it is considered the standard
of care for many tooth replacement scenarios. Implant therapy
applications can vary from single tooth replacement to restoring the
partially and completely edentulous patient.
27April 2007
ever, the advantages discussedabove often outweigh the disad-vantages.
Dental schools in the UnitedStates have recognized this trendand incorporated implant therapyinto their undergraduate curricu-lums. However, the level of expo-sure dental students receive duringtheir time in dental schools variessignificantly from program to pro-gram or from student to student inthe same class. Often, the under-graduate experience is minimal.Unless the graduate undertakes res-idency programs in prosthodontics,periodontics, oral and maxillofacialsurgery, or implant-focused generalpractice residencies, their under-standing of this treatment modalityis lacking, leaving them ill preparedto offer and perform these servicesfor their patient base.
Where does this leave therecent dental graduate? Recenttrends in dental litigation haveshown the profession that this formof tooth replacement therapy mustbe offered to the patient as a treat-ment option; otherwise the practi-tioner is deemed negligent. If thedentist can not perform these pro-cedures, it is his/her responsibilityto refer the patient to a team ofspecialists that can.
The standard of care with den-tal implant therapy is the teamapproach. This concept involves thegeneral dentist working closelywith the surgical team that per-forms all surgical aspects of treat-ment and the dentist planningtreatment and ultimately restoringthe osseointegrated (healed) dentaltitanium root form implants.Fortunately, many private and uni-
Figure 8—After anterior
Figure 5—Posterior single tooth replacement Figure 6—Posterior implant in place
Figure 7—Before anterior
Figure 9—Smile before
Figure 11—Maxillary anterior implant therapy
Figure 10—Smile after
28 Mentor
MENTOR | Implant Dentistry for the Recent Dental Graduate
versity-based learning institutions offer continuing edu-cation programs to help dentists gain the knowledgenecessary to begin restoring implant cases.
More recently, there has been much controversyover the subject of general dentists surgically placingdental implants. Unfortunately, there is very little guid-ance from the profession as to whether this is an appro-priate treatment modality for our general dental col-leagues to undertake. There are many factors that oneneeds to consider when evaluating this question. One ofthem pertains to the legal ramifications.
Arthur W. Curley, JD, is the senior trial attorney ofBradley, Curley, Asiano, and McCarthy, PC, a Cali-fornia law firm specializing in defense of the dentalcommunity. He has represented dentists and tried casesthroughout California and is an assistant professor ofdental jurisprudence at the University of the Pacific inSan Francisco. In September 2006, Mr. Curley, in asso-ciation with the Institute of Dental Implant Awareness(IDIA) forwarded the following to periodontists andoral and maxillofacial surgeons around the country:“From a legal perspective, any licensed dentist can per-form any dental procedure. However, the law holds allpractitioners to the standard of care expected of spe-cialists providing similar procedures on a regular basis.Therefore, although it is legal for general dentists toperform implant surgical procedures, if complicationsarise that result in litigation, they will be held to thesame standards as surgical specialists who had a 3- or4-year residency program that includes management ofcomplications.”
Mr. Curley explains that general dentists are notaware of the potential liability when placing dentalimplants. Unlike postgraduate American DentalAssociation (ADA)-recognized surgical specialty pro-grams, many of the continuing education coursesoffered by either independent organizations and/orimplant companies fail to adequately train the dentist inrisk management. This can leave the dentist ill preparedto handle possible surgical complications and failures.
Currently there are no standards or guidelines forthe minimum amount of training required for generaldentists interested in placing dental implants. The IDIAin association with the ADA recognized surgical spe-cialties, and several dental implant companies are cur-
rently working on developing appropriate guidelines.Until then, my recommendations for general dentistsinterested in incorporating implant surgery into theirpractices are as follows:
• Considering implant dentistry is prosthodontical-ly driven, the implant dentist must first demon-strate proficiency in the treatment planning andrestoration of both fixed and removable implantcases before undertaking surgical training inimplant dentistry.
• Avoid the “Holiday Inn” corporate-sponsoredcourses. These courses are often lacking in riskmanagement training and are essentially biased,with product sales often being the objective ofconducting the programs.
• Seek out independent, multi-day/week surgicalprograms from well-established private learningcenters or university-sponsored continuing educa-tion programs which have risk managementincorporated into their curriculum.
• The standard of care with implant dentistry layswithin the team approach. Consequently, let yoursurgical team know of your ambitions. You willneed their support and guidance throughout thisprocess.
• Start off in the posterior zone with little or noadjunctive grafting required (Figures 5-6). Leavethe anterior zone for the team approach (Figures7-11).
• Considering the majority of implant sites are defi-cient in bone, soft tissue, or both, dentists willtherefore need to take several grafting coursesand be proficient in this area if planning on plac-ing dental implants on a regular basis.
• The cost of adequate continuing education andsurgical equipment in the first year of trainingalone averages around $30,000+ (and this doesnot include time out of your practice). Therefore,the cost of the very first implant placed will be$30,000+, the second $15,000+, etc.
• Finally, you need to ask yourself these questions:Is this a financially viable direction for the practice?Is the increased liability justifiable?Does the team approach offer improved treatment
outcome, predictability and less liability? n
of Continuing Education in Dentistry®
B r o u g h t t o y o u b y
