Monthly Archives: June 2009

Creating Great Contacts

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Recently, while preparing for a lecture on posterior restorative dentistry, I did some research on matrices so I could discuss creating an ideal contact while placing a direct composite restoration. One of the requirements for an adequate matrix is overcoming the thickness of the matrix to create the appropriate intensity contact. As I read this piece of the definition I became curious enough to continue my research and seek a solution to overcoming the thickness of the matrix band.

I was amazed to learn that the act of wedging two teeth apart can take several minutes to be complete. It makes sense as I can think of many times when I have placed a wedge and then before I was ready to place the final restoration had to place a larger size wedge because the first was loose between the teeth.

With this information in hand, I began to place a wedge between two adjacent teeth needing to be restored interproximally prior to beginning the preparation. Usually by the time I am ready to place a matrix, I have to exchange this wedge for one of a larger size. I find it much easier to complete the interproximal preparation as the adjacent tooth surfaces are slightly separated. In addition, I love the resulting interproximal contacts and the reliability with which I create these.
 

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Belt and Suspenders

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Provisionals on veneer preparations can be challenging. The “shrink to fit” or “shrink-wrap” technique has gained popularity over the years. That is, provisionals are fabricated and trimmed on the teeth without being removed and are left until the seat day. I know great clinicians who use this technique but I am insecure with it.

Consider fabricating your provisionals prior to making your final impression. If you place a piece of braided 000 cord into the sulcus prior to fabricating the provisional you can get excellent margin capture. (figure 1)

By removing the provisional and trimming it outside the mouth you don’t have to worry about damaging a margin on your preparation or creating unnecessary sensitivity around the margins by inadvertently cutting into cementum while trimming.

You have the added benefit of being able to measure the thickness of my provisionals before making impressions. If the provisional is thinner than you want your final veneer to be, then you have the chance the make the corrections to the prep before the impression, thereby avoiding having to redo the impression. (figure 2)

 

 

 

 
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Ears on?

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I once asked a favorite mentor what one piece of advice he could give me about dentistry. After thinking about the question for a few moments he pulled a two-dollar bill out of his wallet and wrote “Ask—Listen”. I was disappointed that this great sage didn’t have something much more profound to tell me!

Over the years, though, this has become a treasured reminder of that most basic human need—to be heard and acknowledged.  When I am talking, there is little chance that I am learning about the person who is listening. When I listen, people will tell me their diagnosis and how they would like to be treated.

How would your practice be different if every patient who left the office today could say, “Wow, they really listened and heard what I was saying”? People who feel heard are more likely to trust those who heard them. If your patients feel trust, you have earned the right to begin to speak. Once I earn that right, my case acceptance will rise dramatically.

 

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Lab Communication

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as we finished up an anterior live patient program, lab communication was the theme of the week. At the first session we spent a half day discussing lab communication, with the intent to make sure we as the dentists send all the necessary records and communication so the lab can return their very best work to us in a way that fits our expectations.

One of the cases was sent with just such precision, and the doctor called the technician and explained what was being sent. With all of this the finished case did not live up to the doctor’s expectations. So what went wrong? I can’t answer this without speculation, but it does make me re-examine what we can do to optimize the doctor-technician relationship.

The first change I can make is to approach the conversation collaboratively. Instead of sending records I think are important, I ask my technician what he/she needs to accomplish the outcome I desire. Then we have an opportunity to discuss why we would or would not use certain records or information, and more importantly how we each see these things being used. At the heart of this discussion may lie basic similarities or differences in the outcomes we strive for, our philosophies, and the opportunity to create exceptional results together for our patients.
 

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Will Our Kids Learn from Our Money Mistakes?

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My son just bought his first house. My youngest is juggling an unpaid internship with a paid gig waiting tables and trying to enjoy her last real summer before her senior year of college. My oldest and her husband have started a family and are discovering just how much more it takes to feed (and clothe, and care for) one little mouth.

The financial lessons we try to give our kids at home are one thing, but there is nothing like the “real world” to hammer them home. As parents we’re caught in a constant battle between the urge to rescue or protect our kids and the desire to see them succeed on their own.

Because of my history helping dentists with their economics, I’ve seen how difficult it is for people who start saving too late, and I’ve seen the power of geometric progression work in the favor of those who start early. As it turns out, the next generation has learned from some of our mistakes, and has taken the current economic crisis as a purposeful wake-up call. This recent Charles Schwab survey has some interesting stats – most of them hopeful – about how young adults are dealing with money.

But despite our best intentions, our financial homeschooling is falling short. While young adults say they learned about money primarily from their parents, just 17% feel well prepared to save money for the future and only 15% feel well prepared to invest wisely. It’s understandable, because many of us aren’t confident about our own knowledge around saving and investing. That’s why I’m a huge advocate for programs like Young&Motivated and other resources to educate kids and young adults about money.

55% of young adults believe they will be more successful than their parents. I think that’s what we all hope for our kids, isn’t it? So why not give them the tools they need to make better decisions than we did, sooner, and with more confidence?

 

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Implant Abutment Screw Access

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Those pesky little holes must be filled after the screws are torqued down. The possibility of having to go back in and access the screw is always present. I have used cotton pledgets, fermit and composite over the years to protect the screw heads and it is always messy – I hate the little strands of cotton that always poke out!

Larry Grillo, a dentist in Aventura, Florida gave me a great solution. He torques the screws and then squirts a little bit of light bodied impression material into the opening. I prefer using clear or white bite paste after my ceramist Matt Roberts suggested that colored impression material might cause a color problem in a zirconia abutment under an all-ceramic restoration. The technique works exceptionally well. You can do provisionals over the top without pulling it out and when you do need to remove it, simply pluck it out with an explorer tip.
 

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Beating the Average

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Those who know me know this: I love dentistry. I love the care and caring inherent in our profession, I love the freedom it offers practitioners, and I love the nearly unlimited economic opportunities it holds for those who want to capture them. The recession has done nothing to shake my feelings about our industry – in fact, since our economy started to stumble many months ago I’ve been teaching that we are in a truly blessed profession and that with the right mindset and focus this can be a time of opportunity, not scarcity, for dentists. So when I read this weekend the great news about how dentists are faring in the recession, my first thought was – I was right! (and those who really know me also know that I love to be right).

My second thought – all joking aside– was about the law of averages. Saying that the average practice grew 6.9% doesn’t mean that every dentist experienced growth. It means that some grew 10%, 15% even 20% while others remained flat and still others went backwards. I don’t need statistics to tell me this – in every course that I teach I poll participants and see that some are growing – even in this economy – and some are struggling.

So the real question we should be asking is – what did the most successful dentists do to bring that national average up to 6.9%? What are the best practices of the top few that counter-balanced the struggles of those at the bottom?

Like my partner Dr. Spear, blogging is a whole new world for me. In the next post I’ll be kicking off a video blog series on how to define success for your practice – I’ve done some serious studying on this recently and really excited to share it with you. I’m willing to bet that the dentists who grew in the last year each have a clear definition of what success means to them (and since we can’t interview them all, let’s just assume that I’m right…).

 

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Reflections, vacation, unplanned time…

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After a full spring of seminars, lectures and workshops, I’m embarking on my summer vacation. Vacation is an interesting term to me because it conjures up visions of lying on a beach, fishing, hiking, or other recreational activities. Certainly my vacation will have some of those things built into it, as I leave for Montana with my long time fishing buddy, Jordi, in mid-June for a week of fly fishing. And Charlene and I are going with another group of long time friends to Denali in Alaska at the end of July for another week of photography, fishing, hiking etc.

But  perhaps the most important part of vacation time to me is the non-structured part, the part where I have, for lack of a better term, "head-space".  It is in these unplanned times that I allow myself to ask specific questions about the past year, the present time, and the coming year. My good friend, Brian DesRoches, PhD, who has worked with my network group of specialists for over 20 years facilitating retreats that have kept our group alive and invigorated, always has us ask ourselves three important questions as part of his facilitation.

First, what gifts did you bring to the relationship/relationships over the past year/years? What did you receive from the relationship/relationships over that period of time?

Second, what gifts are you bringing currently to your relationships, and what are you receiving from them?

And finally, what do you want to bring in the future to your relationships, and what do you want to receive from them?

When I use the term "relationships" above, it could be members of a study club, your office team, your personal relationships, or any other situation that works for you. My point is that during most of our year we are on autopilot, following schedules that don’t let us re-examine our lives in ways that allow time for contemplation, setting a different course, or reaffirming that we are doing exactly what we desire to do.

So as I get ready to start my vacation, I am excited about what I have planned, but I can’t wait for the unplanned time because for me it is when I am in my most creative space. And I am sure I will share with you what shows up there.

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Traditional vs. CAD/CAM restorations – Part I

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Our Cerec inLab unit has arrived from Sirona. We will be using digital impressions for the first time in our Posterior Live Patient program. We will be making two sets of restorations on the same patients – one with traditional milling and one with CEREC technology. We will try in both on the patients and compare fit and esthetics. I am eager to experience doing restorations both from a traditional impression and a virtual one and then compare the results in the mouth.

More to come after the class… 

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