Since I was a kid people have complimented my white, well proportioned smile. My childhood dentist often told me I was lucky to have the teeth I had.  Throughout the years I went to my cleaning appointments, took care of a few cavities, and had the occasional chip smoothed. As I grew older, I noticed things that bothered me about my teeth.  It started with the appearance of discoloration and decalcification spots.  Later it became obvious that I had rotated teeth, receding gums, wear patterns, chips and crazed lines in the enamel. My smile was only from cuspid to cuspid, the buccal corridor was not visible and my teeth were all the same length. I didn’t like the way they looked.

Every time I raised these concerns with my dentist I was told that they were simply symptoms of aging. Nothing was broken, so why fix it? I went from dentist to dentist because they seemed interested only in addressing what was needed and not what I wanted.  I wanted even color, longer teeth; I didn’t want to force my smile in order to show my teeth. I desired what every professional at my age wants – a winning smile.

I was stunned when I saw the white wax up for the first time. What I had envisioned was right in front of my eyes. Everything I wanted was there, length, shape, buccal corridor, etc. I couldn’t wait to get stated.  The experience of having my teeth prepped for my new smile was amazing; the simplicity of the process was overwhelming.

The outcome had definitely exceeded my expectations!

The weeks after the placement of the temps passed quickly, and before I knew it I was back at the dentist’s office to receive my permanent teeth. The bonding procedure seemed as simple as the prepping. I was pleasantly surprised at how strong the restorations appeared and how natural they felt in my mouth.

What I didn’t anticipate was how emotional the experience would be. I was blown away by the impact my new smile had on my appearance and my confidence. My expectations had been exceeded.

Reflecting on this experience I feel truly blessed. I always knew that I worked with highly skilled professionals who were passionate about their work. But to see the culmination of all their efforts in my new smile was both gratifying and humbling. I wish that all patients could experience the transformative power of comprehensive dentistry.

I extend my heartfelt gratitude to Dr. Dan Hillis and the Arrowhead Team for their great work. I now have the winning smile I have wanted for years.

I agree. If technique oriented technology can be predictable, attainable, and sustainable in a small dental business, chaos is crushed and a practice will thrive. We’ve had great success with this approach. In fact, many practitioners have heard me refer to our strategies as “swords.” Some call them gems, pearls, or secrets of success.

Think of an analogy wherein martial arts are compared to the art of dentistry. If you practice only one particular maneuver to an oncoming threat, it will work . . . most of the time. However, the time will come that it will not work, creating stress, fear, and doubt. Sound familiar in your practice? Let me share ten “swords of truth” that can help with your technique and leadership skills.

1. BioResearch’s JVA (Joint Vibration Analysis)

This technology “sword” provides an immediate, straightforward analysis of TMJ health. The information is invaluable for assessing the impact of your treatment for TMJ, orthodontics, reconstruction, and sleep apnea dentistry. It can be recorded in two minutes by delegating to trained staff members, whereas traditional X-rays and Doppler auscultation are difficult to master.

2. Tekscan – T-Scan Occlusal Analysis

This “sword” determines both biting time and force. The T-Scan III takes the guesswork out of dental occlusion by measuring force and time on left and right sides of the arches. It provides excellent documentation and patient communication.

The practitioner can use the T-Scan to appraise maximum intercuspation (MIP) or in centric relation. Quick assessment of lateral excursion in relation to cuspid rise efficiency. This captures a patient’s attention, which in turn enhances the practitioner’s professional image. Equilibrating a dentition with certainty of which occlusal mark came first is paramount.

3. CO₂ Laser

This “sword” is considered the most efficient laser wavelength for soft tissue manipulation and removal. Target tissue is sterilized to eliminate bacterial contamination and dramatically reduce wound healing by sealing off lymphatics, blood vessels, and nerve endings. Depth of the laser cut is only one-tenth of a millimeter, which translates to precise control.

The CO₂ laser is the only laser that can be used successfully directly with peri-implantitis. It fosters wound healing with little or no post-op discomfort. A hygienist can use the laser in periodontal pockets for decontamination. State-of-the-art electronics give this laser a wide range of procedures. Same-day soft tissue manipulation and tooth prepping can be done with total predictability.

4. Digital X-Rays

This “sword” uses a digital X-ray sensor instead of traditional film. Practitioners gain several advantages, such as immediate image review and availability, enhancement of image for better diagnostic review, and the elimination of processing film chemicals. And most important, the sensor dramatically reduces the amount of radiation needed to produce the image as opposed to film.

5. Digital Impression—Itero from Cadent

The three fundamentals of restoring a tooth with a crown, onlay, or inlay are

1. Proper reduction for material of choice
2. Clearly definite prep finishing margins
3. Proper registration of the articulating surfaces

Properly done these steps ensure a relatively smooth and adjustment-free insertion of laboratory-fabricated restorations.

This “sword” has clearly changed my practice for clinical efficiency, reduced consumables, eliminated gagging, and provided total predictability. Traditional methods require 14-16 steps in my office versus 3 steps with Cadent to send a case to the lab.

6. Electric Handpieces by KaVo

This “sword’s” biggest advantage is its powerful, constant torque for faster and more precise preparations. KaVo makes a brushless motor that is one of the shortest and lightest, plus it is whisper quiet. The water spray is conveniently located on the motor and reduces reaching for the main delivery unit. Traditional air-driven handpieces are less efficient and are more traumatic to the tooth. Patients prefer the electric over air in my practice.

7. People Smart: Powerful Techniques for Turning Every Encounter into a Mutual Win

This “sword” is a must for those who want to help others feel comfortable, with little or no tension. It focuses on how to truly relate to others’ wants and needs.

One surprising take behind the book is that the “Golden Rule” of “Do unto others as you would have them do unto you” is false. The important thing is to “Do unto others as they want done unto them.”

With this book, you will learn how to read people of all kinds quickly. You will learn to treat them how they would like to be treated. This would have been great to learn in dental school, but too often that never happens. Get this book to help your staff become more attuned to patients.

8. Comprehensive Diagnosis

This “sword” is an absolute must in fully understanding your patient. This designates the combination of signs, symptoms, and test results that the clinician uses to attempt to determine the correct diagnosis. Dr. Dick Barnes’s CD set on case presentation is truly the best in providing a structure for predicable results.

9. Creating a Mastermind Dental Office (Staff and Doctor or Doctors)

This “sword” concept was formally introduced by Napoleon Hill in the early 1900’s. “Mastermind” participants bring a synergy of energy, commitment, and excitement to the group or, in our case, the dental office. The key questions we have worked on are:

• What is your business mission or vision statement?
• What are your 5-year goals?
• Where will you find time to participate? (We have weekly meetings.)
• What is your commitment to moving forward in business?
• Why should you participate in a Mastermind group?

We strive to make each year extraordinary by setting goals at the start. Come prepared to ask people to leave the group (office) who are not participating up to the group’s standards. Do it quickly once the poor behavior becomes evident. A “slacking” member of the group will drain energy and fun from the whole group.

10. Authenticity

This “sword” is often referred to as the truthfulness of origins, attributions, commitments, sincerity, devotion and intentions. Consider your practice. “Fake,” “contrived,” “phony,” “disingenuous”—do your patients ever say this about it? Is this how they feel when being presented with a treatment plan?

Today, consumers, patients, and clients view companies in terms of real and fake. They want to buy a real product from someone genuine—not a fake product from someone phony. Goods and services are no longer enough.

What patients want today are experiences—memorable events that engage them in an inherently personal way. This is difficult in production-line dental practices. The Dr. Dick Barnes Group has sparked many dentists to become authentic leaders. The group has helped today’s dentists become more successful in their practices.

Our world is constantly changing. You become what you focus on. Hone your business strategies with the best “swords,” and your enhanced practice will see constant, never-ending improvement. Take the path of least resistance and select inferior swords, and patients will see your service as fake, not real. Select swords that truly reflect who you are, and use them to provide the best dental care possible.

Your patients come from the same general marketplace as the comprehensive dentist, and it’s a 3-5 mile radius of your office. The difference in doing and not doing comprehensive dentistry is training, believing in yourself, and seeing your world differently.

I have watched thousands of dentists over the past 40 years make changes in their lives and practices and become the person and dentist they had dreamed of becoming. The changes came about by learning to believe in themselves and by doing away with self-defeating behaviors.

When was the last time you questioned who you are and what you stand for as a person and a dentist? Chances are it was quite a while ago. A dental practice evolves into the way we see the world around us, which is whatever other dentists are doing or the fees they are charging. We open a practice, hang out a “shingle,” and hope someone calls so we can pay our school loans, our mortgages, and have money left over for ourselves.

Listen to your inner coach and start seeing your world differently.

This thinking or belief is called “self-defeating” behavior. Now is the time to revisit who you are and what you stand for and ask of yourself what do you believe. Beliefs have direct impact on our character and our behavior.  This evaluation of yourself is the beginning of dissatisfaction.  Changes don’t come about until you realize you’re dissatisfied with the your present situation.

The way you see yourself and your practice is the way it will be. The view might be negative: I can’t accomplish it in my area, my patients can’t afford that kind of dentistry, and the economy is bad. The negative little voice in your mind is known as your inner critic.

Your patients need your help with their dentistry and are relying on you and trusting you. If you get them to see the VALUE in having procedures done, they will get the money. Besides, the economy isn’t so bad—90% of the people are working and the economy has not affected them.

The positive voice in our mind is known as our coach. This is the voice of confidence and encouragement. It is the voice of hope and the way to success. Your inner coach checks for solutions, not problems, and it provides you with inspiration and vitality.

The positive voice teaches you to replace fear and doubt with faith and hope. When you have faith and hope, you have no fear and doubt. They can’t dwell together—you have one or the other. The inner coach teaches us to be positive and to have faith and hope.

The mind can waste a lot of energy on self-defeating beliefs. Remember that a belief is not a fact. You should not think that what you believe about yourself today is necessarily true. What you believe today may be questionable today and wrong tomorrow—dissatisfied.

I no longer practice dentistry, but when I did, I practiced with a positive attitude and tried to provide the best dentistry possible. Now I dedicate my time to helping dentists realize and recognize their inner coaches. I help them become better dentists and more productive and self-satisfied.

Watching dentists change brings the same sense of accomplishment I received when I had completed a difficult reconstruction case. Listen to your inner coach and start seeing your world differently. If you practice these principle, I guarantee you a new joy and happiness you never thought possible.

About two years ago, Jeff walked into my office. With a hint of desperation in his voice, he asked if I could fix his teeth. His chief complaint was that his lower teeth were tearing up his lower lip and his smile was embarrassing to him.

I found Jeff’s mouth very intimidating, to say the least. He was what Dr. Downs would describe as a “blockhead brachiocephalic.” He had massive masseter muscles that seemed to say, “I will destroy anything you put in my mouth.”

Jeff’s lower anterior teeth were broken and worn down to nubs. I was not even sure they were restorable. His profile was collapsed due to dental overclosure.

Jeff’s previous dentist had recognized the need to increase his Vertical Dimension of Occlusion (VDO), and he had fit him with a lower bite splint that opened Jeff’s bite about 6mm. He wore it for several months and tolerated it well, then he lost interest after leaving that dentist due to personality differences.

I was completely honest with Jeff. I told him he needed full mouth reconstruction, but that I didn’t have the necessary skills and training to help him. If he could be patient, I would learn the skills needed and fix his teeth and his bite. I sincerely wanted to help—I couldn’t bear to see Jeff in hygiene every six months and just ignore his plea for help. He seemed satisfied with my pledge to help him. Now I felt the burden of a promise that I needed to make good on.

Jeff had massive masseter muscles that seemed to say, “I will destroy anything you put in my mouth.”

Then one day, my brother—a dentist in another state—called and asked if I knew anything about Arrowhead Dental and the courses they offer. Though Arrowhead is local to me, I didn’t know much about them. I did a little research and found out they taught occlusion and full mouth rehabilitation courses.

I decided to show the course instructor the pictures and models of Jeff and get his advice. In truth, I was getting a feel for Dr. Downs and his dental philosophy. I was very impressed. He took time out of his schedule to meet with me and review my case. Jim was so down to earth and easy to talk to. He told me Jeff’s case was very treatable with the right knowledge and skill set.

Dr. Downs invited me to an over-the-shoulder course where he prepped and temporized a whole arch in one afternoon while explaining the steps and procedures. The patient cried tears of joy when she saw her temporaries. I thought to myself, “I want to do that kind of dentistry.”

The next day, Dr. Downs seated a whole arch of porcelain crowns on a different patient. I really enjoyed this course. Dr. Downs was a masterful lecturer who connected well with the small group of dentists. I realized that I shared the same level of understanding as the dentists there. Other dentists in the group had been to this course before and had returned to get a deeper understanding. No question was too basic to ask Dr. Downs.

A few months later, I attended the everyday occlusion course taught by Dr. Downs. It built upon the previous course. Then I was invited to do a hands-on course where I would actually take a patient to Dr. Downs’ office to prep and temporize one weekend, then seat restorations three weeks later.

I had a major scheduling conflict, but just four weeks before the course I decided to clear my schedule and make attending a priority. I invited Jeff to be my patient. He was so excited—he was finally going to get his teeth fixed! For me to learn these new skills, I first needed to hear, then be shown, and then conclude by performing under supervision. That’s exactly what this series of courses did for me.

As part of the preparation, I took a swallow/stick bite on Jeff. This is performed by putting a cube of red rope wax on each of the lower molars. The patient puts the tip of his tongue as far back as possible and lightly bites into the wax. He then relaxes his tongue and swallows about eight times a minute. Every time he swallows, his teeth sink further into the wax cubes.

Meanwhile, the dentist uses a Boley bolley gauge to measure the distance between the cementoenamel junction (CEJ) of the upper central incisor and the CEJ of the lower central incisor. When the desired measurement is reached, a bite registration material is injected between the teeth and around the wax. This will be the patients’ new VDO.

This number is referred to as the Shimboshi number. With Jeff’s teeth closed and without the wax, his Shimboshi was 11 mm. An average person without pathological wear will be between 16 and 18 mm. I opened Jeff’s bite to 16.5mm with the swallow bite. This new VDO was similar to the bite splint Jeff was comfortable wearing. The swallow bite was sent to the Arrowhead lab, and they waxed up the case at the new VDO.

Dr. Downs and I decided we would prep and restore Jeff’s upper teeth and place splinted snowcap resin temporaries on his lower teeth. These temporaries can last 1-3 years. This would allow us to hone in his bite and let Jeff replace the lower temporaries when his budget allowed. If resin temps are not used, a lower bite splint can be worn to hold the new VDO until the lower teeth can be restored.

Before we prepped Jeff’s teeth, we evaluated his occlusion using the TekScan. This demonstrated that 72 percent of occlusal pressure occurred on the right side, opposed to 28 percent on the left side. We also performed a joint vibration analysis, demonstrating that Jeff’s TMJs were remarkably healthy despite the extensive dental pathology.

Jeff resisted strongly when asked to smile for pre-op photos. Due to embarrassment, he had become so used to hiding his teeth when smiling and laughing that it was difficult to show them as he smiled for our camera. Dr. Downs told me that would change.

Jeff tolerated prep day despite the long learning process. Dr. Downs was there every step of the way, talking me through each step. I was impressed with the Arrowhead Elite Team’s preparation. I was given prep guides showing exactly how much to prepare the teeth.

When Jeff and I flew back home to Salt Lake City, his wife was waiting for us at the airport. She cried tears of joy when she saw Jeff’s beautiful temporized teeth. She commented that it was the first time she could actually see her husband’s teeth while conversing with him. It was an emotional experience for all of us.

We placed gold crowns on the upper second molars and IPS e.max crowns on the other teeth. To the Arrowhead Elite Team’s credit, the restorations seated with very few adjustments. With the help of the Tekscan, we were able to equilibrate Jeff’s occlusion to perfection.

Jeff says his bite feels amazing. His muscles of mastication are relaxed, now that they’re at the correct physiological length. And, yes, Jeff has learned to smile.

Well, my journey still continues. When I went back to my practice, I noticed I had many patients that could benefit from this type of dentistry. I still consult with Dr. Downs and the Elite Team at Arrowhead on each case. It just makes it easier when you have such a great team to support you.

When done properly, dancing and dentistry transcend technique and become art. When done poorly, they quickly degenerate into chaos. In dentistry, if a procedure does not go as planned, a feeling of panic typically ensues. The mark of a good partnership, be it dance partners or dentist and assistant, is the ability to recover from the unexpected without missing a step and without the patient noticing.

For large-case dentistry to become a big part of your practice, you and your assistant must develop a choreography that makes communication and collaboration second nature. Although cases and patients will vary, the basic steps should not.

As the dentist, you are the lead, and you are responsible for setting the timing and tempo of each movement. This ensures seamless coordination between you and your assistant. Without a strong lead, the procedure will unravel into a series of missteps that will leave all participants disappointed.

Boost your productivity with these bonus tips by Karly Alcorn, Dr. Miller’s assistant.

Rather than alerting the patient to what he or she may consider a gusher of BP proportions, we handle the whole situation by uttering a simple word: stasis. This initiates a choreographed series of steps that address a routine inconvenience without any perceived drama.

Let me emphasize, you must have practiced these steps with your assistant prior to expecting this level of efficiency. If you are consistent in using this approach, your assistant will quickly recognize when and what is needed. Soon, not even a word will need to be spoken. What once required direction now becomes the fluid movement of two highly skilled professionals working as one.

Besides verbal communication, visual cues and prompts are also helpful. In my office, a nod can speak volumes to an attentive assistant. That simple signal can mean I need the tooth of interest to be rinsed and dried, and I need my mirror to be dried. A tap on the cotton roll will tell her that it’s time for replacement.

Again, while teaching and practicing simple gestures within the context of procedures is simple stuff, it must be done in advance. Expecting an assistant to intuit what you want without having rehearsed the steps will devolve into an exercise in frustration.

A verbal game-plan review before you “dance” in dentistry will keep you from stepping on each other’s toes. After the procedure, an open and honest critique of both your performances will ensure continual improvement. No matter how well the procedure went, every great team will find at least one area to improve next time.

Doing complex, life-changing dentistry can be intimidating to even the most seasoned dentist. When I decided to make full mouth reconstruction a regular part of my practice, I attended a Full Arch Reconstruction seminar taught by Dr. Jim Downs.

While at the seminar, I witnessed the power of “clinical synchrony,” which is the ability of doctor and assistant to work as one. As I watched Dr. Downs and his assistant do a full arch in a few hours, I realized that doing the procedure was less a question of skill than it was of effective teamwork.

Recover from the unexpected without missing a step and without the patient noticing.

Just as an accomplished dancer must master multiple styles of dance, you and your assistant must be able to accommodate the needs of different patients. I’m talking primarily about how the procedure is presented. For example, by nature I am witty and light-hearted, and for most of my patients, that is a great fit. My assistant is a great complement to my personality. We click—like a dental version of Fred Astaire and Ginger Rogers. If you don’t have your Ginger, you need to find her quick.

That said, not all patients appreciate the jazzy approach. Never fear. Fred and Ginger can waltz, fox-trot, tap, tango, swing or whatever we need to do to please our patient. We’re not being fake or insincere—we’re just picking up on our patients’ unique tastes and acting accordingly. The ability to change up “steps” has come only after we have mastered the basics.

Up to this point, my discussion has centered on three people. But this dance goes way beyond the dentist, assistant, and patient. In reality, another important team exists outside the operatory. To achieve true greatness, the dentist or dancer needs an expert instructor or mentor. Nobody can achieve greatness alone.

The Dick Barnes group has been my template for success. While I used to have two left feet, with the group’s help, my team and I can seriously cut a rug. Arrowhead Dental Laboratory has also been a key player. Without their artistic input, our dancing would not have the polish that our patients have come to expect. Judging from the number of people who want to dance with our team, I would say that we have developed some great moves.

Do’s and Dont’s for Dental Success

Do:

• Always have a wax-up, a reduction guide, and provisionals done for every large case. This is in addition to a full-mouth series of radiographs and intraoral and extraoral photographs. You need them to communicate well with all parties . . . don’t get on the dance floor without them.
• Be bold but wise. Don’t overreach, but always expand your comfort zone. Seek wise counsel to help with questions during case preparation. This is where mentors like the Dr. Dick Barnes Group come in.
• Tell your assistant in great detail about any “steps” that could change during a procedure, such as a possible endodontic shuffle.
• Remember that you have a person in the chair. It’s too easy to develop tunnel vision during intense and lengthy procedures.
• Evaluate your performance and your partner’s openly and honestly. Compliment each other while also offering positive criticism. There’s no room for egos with a patient’s smile on the line.

Don’t:

• Leave your partner out of the continuing education courses that you take. It’s hard for someone to perform competently in a dance they’ve never seen.
• Underestimate appointment time at first. Patients always appreciate the extra level of service, and it will cut your stress level in half.
• Ever let the patient see or perceive any stumbles. They should already think you are Fred and Ginger. Don’t turn into Jerry Lewis.
• Undersell your patients with less than first-class treatment. With top-rate training, you can and will deliver a performance that will leave you, your partner, and your patients breathless and looking forward to the next dance

Related Articles: The Dance – An Assistant’s Perspective

Relationship-building starts at the first phone call, continues when the patient enters the office, and grows as the patient meets the doctor and various staff members. Everything is accomplished in a step-by-step process laid out in a planned “structure.” Nothing, and I mean nothing, can replace building a good relationship with patients. It’s the foundation for every interaction that will take place.

A successful office wants to know each patient’s story. When I see an office that doesn’t have any stories to tell, I can guarantee it is not doing much comprehensive treatment. Take the time to listen carefully.

Before patients see the need to proceed with comprehensive treatment, they must perceive its value. The greater the perceived value, the more treatment they will do. As Dick Barnes teaches, Value equals Benefits minus Cost. When the benefits exceed the cost, patients see value. Total Team Training helps make payment a seamless part of the treatment presentation.

Make building a relationship priority number one.

Communication happens in many ways. Most people aren’t aware of this, but listening is one of the most vital steps. How you listen is important. You must listen actively as well as reflectively.

The ability to show empathy is another important communication skill. While we as treatment presenters typically listen well to patients and say the correct words, too often we mess up the visual aspect. We bring in models, X-rays, and anything else we are comfortable with, and patients nod but obviously cannot envision the same things without a more technical background.

Fortunately, technology has come along that can assist in this envisioning process. How many times have you heard a patient say, “My back teeth don’t hurt and you can’t see them anyway”? Patients have a hard time believing what they can’t see. And no, patients can’t read X-rays. This is where advances in dental technology can help.

The moment a patient comes for an initial visit and sits down in the dental chair, show exactly what is going on in his or her mouth. Enlist the help of hygienists and assistants as well, and relate what you see to the patient’s overall health. This appointment will determine case acceptance.

First and foremost, do not be afraid to diagnose comprehensively. You don’t need to share everything with the patient at this juncture, but you and your staff should begin a process of co-discovery with the patient. Dr. Barnes was far ahead of his time when he began showing his slide presentation at the consultation visit. He understood the importance of visualization.

With today’s advanced technology, we can take that a step further. We can do a smile design simply by taking a photograph of the patient. We can follow that with a computerized design, which shows the patient how he or she might look like after treatment.

Another great but often underutilized tool is the intraoral camera. To use this tool fully, we should take pictures of every tooth in the mouth. This will help patients visualize how healthy—or not—their teeth are.

Consider for a moment if the camera could also detect decay. Well, the Sopro by Acteon can do just that. Its proprietary software can take an optical image and detect any decay. Not only can patients see old restorations that are failing, cracked and broken teeth, but also the active decay process. This adds a sense of urgency and helps validate treatment recommendations instantly. Fear and doubt are erased and the patient gains trust.

As previously stated, before investing in new technology, it is prudent to invest first in communication and relationship skills. Consider a program like Total Team Training. Successful case presentation is all about creating a good, trusting relationship; diagnosing comprehensively; helping patients visualize what they want or need; then sitting down and having an honest conversation about treatment. Everything will be in place for a great outcome!

Enter Captek, a traditional PFM restoration material that is breaking new ground. Whereas this type of material has increasingly taken a back seat in the new wave of esthetics, Captek retains every PFM advantage and provides unsurpassed esthetic results. It’s the perfect material for restoring crowns and bridges.

Captek is a composite metal, not an alloy. When used as a porcelain substrate, it virtually duplicates the optical properties of enamel’s underlying tooth structure. In my experience, with factors like lab technician skills and the quality of clinical records being equal, it may be easier to attain the highest level of esthetics using all-ceramics. But in the hands of superior ceramists like the Elite porcelain team at Arrowhead, Captek can also achieve an ultimate vitality.

Captek’s strength, toughness, and masking ability make it applicable under more conditions than many of its metal-free counterparts. These conditions include occlusal loads, parafunctional habits, discolored tooth structure, and margin placement. Thus, Captek has become the mainstay of my crown and bridge practice since I first used it in early 2002.

Clinically, I choose Captek for cases where structural forces may still be problematic, even after occlusal therapy. I use it when I’m hesitant to use all-porcelain restoratives. Also, Captek is appropriate for short- and long-span bridges anywhere in the mouth, while most metal-free materials are not recommended for bridgework behind first premolars. Discoloration of the underlying tooth structure is common in non-vital teeth. With the exception of Zirconia, the discoloration can reflect through all-ceramics, compromising the resulting esthetic outcome.

Zirconia’s strength is superior to that of other all-ceramics, making it conventionally cementable. Another benefit is that it will camouflage the darkening often seen in non-vital teeth. Ultimately, however, I have found Captek’s strength superior to that of Zirconia, whose esthetics are the least life-like of this new generation in materials. Most other metal-free indirect restorations are bonded, whereas Captek units can also be conventionally cemented.

When clinical circumstances such as location or new decay dictate that margins be placed subgingivally, this becomes a distinct advantage. Captek’s unique bacteriostatic properties promote periodontal health, and studies have shown that surrounding gingivae appear more natural with Captek crowns than other restorative materials.

Earlier in my career, I was often frustrated when my perfectly placed margins became exposed in a few years by angry-looking gingivae in a clean mouth (fig. 2). Since I started using Captek, such cases have become virtually absent from my practice (fig. 3).

In short, Captek is my crown and bridge restoration of choice. Applicable in nearly all situations, it more than measures up to any other in terms of soft tissue compatibility, lifelike esthetics, and long-term function. And by the way, the tooth restored with a Captek crown in fig. 1 is #13.

While touring Ivoclar’s phenomenal facility, we received several product lectures and demonstrations. My son, a third-year dental student, also attended. While our initial intent was to get the latest information on dental products, we came away with an unexpected awakening. The visit put the quality of dentistry that I—and many other dentists—practice each day in question.

A number of topics were covered pertaining to materials and their application. Ivoclar has introduced to dentistry an all-ceramic material that redefines the standard of choice in cosmetic dentistry. This lithium disilicate material has very high strength and durability, yet maintains superb esthetics. Whether it is Ivoclar’s IPS e.max Press or IPS e.max CAD, lithium disilicate demonstrates wear compatibility and sustained biocompatibility.

The visit put the quality of dentistry that I—and many other dentists—practice daily in question.

As with other restorative materials, lithium disilicate restorations require ideal preparation design. Physical stability and intimate bonding of the ceramic to the prep depend on proper occlusal reduction and shoulder margins that maintain smooth, rounded line angles. This is imperative.

The internal surface of the restoration must be chemically etched with hydrofluoric acid for 20 seconds, then silanated. When internal surface preparation is done, it must not be overly treated, as this can weaken the bond.

The experience that impressed me the most was the subject of bonding chemistry. I graduated from dental school in 1979 when bonding and composites were in their infancy. PFM crowns had become the standard for tooth reconstruction.

Over the past thirty years, products have changed dramatically. The composite matrix and bonding chemistries have filled the gaps in stability, function, and esthetics.This has occurred in tandem with equally amazing advances in ceramic restorative materials. In my practice, the dentistry that I do most often and find most rewarding involves using composites or ceramic restorations.In other words, I heavily rely on bonding chemistry.

The greatest wisdom gained from my day with Ivoclar was the importance of proper application in chemistry. Successful bonding starts at the very beginning of tooth preparation, and it’s just as critical in the final moments of delivery to the mouth. When the chemical application of any product is not followed to the letter, the end result most often is limited, with questionable success.

Dentists see failures in the form of crowns debonding or suffering ceramic fractures. My practice is not confronted with substantial crown fracture or bonding failures, but Ivoclar educated us on how to predictably improve daily results by simply following fundamental principles.

How often do dentists get new products, jump into using them, and apply them on patients without reading MSDS data sheets or instructions? Maybe we even ask the sales representative for a quick show-tell-do lesson. Big mistake!

Conventional cementation requires a retentive preparation and a tight fit, which is not as critical for adhesive cementation. It’s also less restrictive about which materials can be used. With regard to all-ceramic restorations, a bonded restoration is much stronger than a conventionally cemented one.

In general, bonding cements are more tenacious than conventional cements. The objective of bonding cementation is to create a retentive restoration, seal the margins, reinforce all-ceramic restorations and maintain esthetics. Adhesive cements are more dynamic than self-adhesive cements. Bond strength and fracture toughness is higher for all-ceramic restorations when bonded. While more steps may be involved in applying adhesive cements, the long-term results are improved.

Bondingis more critical and technique-sensitive than dentists may realize.It affects retention performance and long-term esthetics. It can also increase the time needed for clean-up at the placement site. Still, when done properly, bonding can actually be much easier to clean up.

A dry, clean area around the tooth prep is imperative before applying the bonding primer. Before cementation of all restorations, interior surfaces must be silanated. Note the interior, not the exterior, of the restoration.If these precautions have not been taken during placement of the silane, then the excess is distributed in non-bonding areas.As a result, any excess cement or flash around the margins will be difficult to remove.

Sometimes the complaint from practitioners is that the bonding material is too difficult to clean up and remove. “It sticks to everything around it” is a common phrase.

Is this more an indication of the method of placement or product? The material is obviously effective; perhaps those who apply the material are placing it in excess or using the air too aggressively. One must take particular care when blowing air over the tooth and restoration, keeping in mind the ease with which material can spread onto non-bonding areas.

Confusion seems to permeate our profession with regard to bonding. In fact, one of the dentists at our meeting echoed that feeling in describing his frustration: “Technology is moving faster, and it becomes difficult for dentists and ultimately their staff to keep up with the changes.”

The number of new materials and products introduced increases dramatically from year to year. The competitive market is what nurtures this research and development. For those of us in my generation, we can attest to the superiority of new products from those we used in the past. Thus, quality companies constantly strive to improve and maintain new products, which help dental professionals stay on the cutting edge of performance.

This can be a two-edged sword.The end result definitely is a benefit, especially for the patient, but it also fuels the need for clinicians to understand these new materials and their parameters of use and function.

As my son and I were driving home from Ivoclar, he expressed that dentistry appeared to be in a constant state of flux due to the advancements occurring daily. He now understood that his future degree would merely be a license to pursue more education by virtue of the constant changes. What he concluded was that in order to provide the best quality of care, a dentist needs to stay tuned to materials and their application.

Based on the knowledge I gained this day, I have begun torethink how I use and apply materials to bond and cement restorations. While I currently use multiple brands, I have started to ask myself:  Even when the results are satisfactory mixing brands, are they the ultimate results?

The multiple products in our office have created a lack of continuity. They may at times slow up the process. So I decided to streamline the inventory and rely on what I perceive as a better approach. We do this everyday in our lives in many different ways by delegating to those around us. We ask others to decide, perform tasks, or in this case, rely on a business that produces materials based on compatibility and long-term success.

Ivoclar has proven to be the right company to entrust with this task, just as Arrowhead is my principal laboratory of choice. In other words, I have entrusted them to provide the most optimal product from evidence-based science, which benefits my patients. They, as successful companies, are invested in knowledge and product. I find it only rational to find those companies, trust in them, and collectively manage the partnership of materials for clinical care.

The chemistry involved in dentistry is becoming exponentially more complex. For my practice, I have decided to streamline operations. We work with products proven to be chemically compatible, lessening the complexity for me andmy staff.These are words to bond by.

Now what? Of course you want to go to the next level. You wonder, “What else can I do? Can I offer more and make my practice better?”

The answer is yes. First, you can—and should—continually expand your education. Invest in advanced clinical training.

Next, train your assistants to be your “other” hands and help you accomplish more. Once you start making a profit, invest in new technology that will make treating patients easier.

Learn how to diagnose your practice. If your business escalates and then drops precipitously like a roller coaster, you should be concerned. This is a symptom that must be treated.

Let’s say you have had a great month. Do the people in your office celebrate too long? Do you lose the desired intensity? Don’t “rest on your laurels.” Just like in a sporting event, let your team celebrate for a day or two, then get back to work.

Avoid the temptation to “coast.” When schedules are full for a couple of weeks, it can feel less urgent to keep working on them. For example, if a hygiene schedule is booked out, we don’t worry much about contacting overdue patients. We leave it until later when scheduling starts to fall apart.

Don’t wait! New patients are vital to a growing practice. Are you marketing to them well, both internally and externally? Do you always have time available for new patients—or is your office “too busy” to accommodate them? Take another look. Perhaps some scheduling principles are being ignored, but this is easy to adjust. You can learn how to schedule the most effectively at a Total Team Training course.

All too often, as an office enjoys success, the team begins to assume “It’s all about us.” While no one person is named, this can be harmful. Remember: The total focus of your dental practice must never change. It’s all about helping the patient.

Recently, a dentist with a very successful practice shared that numbers had dropped and they would not be going to the next level in treatment options. I inquired about their new-patient flow and their hygiene schedules. I then asked the dentist to share a recent story of one of his patients.

At this unexpected reality check, the dentist became very quiet. A few days later, this teachable man called me back and said, “Tawana, our patients still have stories. We were hearing them but not really listening.” Consider that experience while I share another.

Joshua Bell is perhaps the world’s finest violinist. Tickets average $100 to hear him in concert, and his performances constantly sell out. Bell performs on a 1713 Stradivarius violin that cost him $3.5 million.

In 2007, Bell played unannounced in a metro station in Washington, D.C. The people who conducted the experiment were warned by experts that a crowd would surely gather, thus posing a need for added security.

Bell began to play the six most beautiful songs in his repertoire. No one stopped. Soon a thousand people had walked by, captured on video. Everyone was hurrying on because they had other things to do. They did not recognize the maestro, and only a handful of people even noticed him. Why? They were hearing but not really listening.

If we truly listen to our patients, we almost automatically get to the next level. When I visited a dental practice recently, I watched as a man shared how he had never shown his teeth while smiling at his young daughter. He was so ashamed of them.

The dental staff listened and gave the patient hope. He proceeded with treatment and can now show his teeth with confidence when he smiles. The dental practice gained a happy, satisfied customer. Not only is this good “business,” it’s personally rewarding as well.

Author Annette Simmons says, “The missing ingredient in most failed communication is humanity.” As you approach patients each day, do it with humanity and compassion. Listen to their needs—and solve them with expert care—and you will get to the next level.

While Las Vegas headliners Penn & Teller demystify magic tricks and illusions, I’ve discovered that there are no claims, tricks, or myths that make the Dr. Dick Barnes Structure so successful. The structure we share with teams across the world is just this—a structure that simplifies how you treat every patient who walks through your door.  This is a systematic approach with predictable results.

The structure has no illusions. For those of you expecting a mystical answer, you’ll be highly disappointed. We don’t charge an expensive fee to teach you “tricks” behind the magic. Instead, knowing the structure and how and when to apply it—then following through and relearning and applying the principles—is what makes this all work.

To more fully explain the structure in our everyday communications with doctors and their teams, we engaged in a project. The intent was to come up with a common definition and help guide the entire team during implementation. As a team at Arrowhead Dental, we are always listening for ways to improve upon our services. We are always looking for opportunities to help teams progress.

People get the most benefit when they are mentally ready to change.

During the “transformative weekend,” the doctor learned how and when to apply the structure. He discovered that people get the most benefit when they are mentally ready to change. It’s imperative to set aside existing habits and come with an open mind.

As we talked, the doctor reiterated Dr. Dick Barnes’ teachings that implementing the structure requires a commitment from everyone in the practice, regardless of their years of experience. Saying “Yeah, but” is a self-defeating behavior. Instead, say, “Why not?” and keep an open mind. You can’t achieve full potential by adopting only pieces of the structure. Success will come, but the implementation can’t happen all at once.

While the structure contains several key areas, I’d like to focus on three of the most critical. You will see immediate results as you learn the rest of the structure and what to say and do when. The doctor I just mentioned said, “It is a choice—I choose to get patients to do the things they need to do.” He is now experiencing this change and loving the results.

Abracadabra #1: Turn every patient into a new patient.

In many dental practices, new patients are treated differently than existing patients. This results in lost revenue and unrealized dental treatment.

Dental techniques and technologies are changing rapidly, as are the needs of your existing patients. By taking the time to actively listen, co-discover needs, and communicate, the dentist and staff can provide value-based, comprehensive care that will dramatically impact the patient’s life and office success. In the Total Team Training course, our educators do a phenomenal job teaching office staff how to accomplish the most from every interaction with patients.

Utilizing the team to help build relationships is crucial. Allow your staff to discover these items and learn to ask the questions that lead to potential. Truly it takes the entire TEAM to help build relationships that last.

During this step, we also discuss the importance of discovering patients’ stories. Do you know yours? Learn how to recognize unrealized opportunities that can benefit your patients.

Abracadabra #2: Present comprehensive dentistry to every patient.

Too often, the diagnosis in dental offices is determined by insurance or the patient’s ability to pay. Dentists should present every dental treatment that is necessary to restore a patient to full dental health or to provide the confidence and esthetics desired. Let the patient determine finances—insurance is only a benefit at this rate. Be careful not to prejudge a patient’s ability to pay.

I know what many of you are thinking. “Time is money, Peggy, and I don’t have time to waste.” Or, “My patients will only do what insurance will cover.” Where do these thoughts come from? Dr. Barnes often talks about success versus confidence. You must have success to build confidence.

We provide the tools to present the dentistry that every patient deserves, then we provide a way to fit this type of dentistry into their budget. Remember that patients come to you because they trust your skills, care, and judgment; they trust that you are looking out for them. If something needs to be done, tell them! Let patients determine how they can pay for it.

Abracadabra #3: Effective scheduling focuses only on today and tomorrow to meet daily production goals.

Dental practices that fill the schedule just to fill the schedule are just “staying busy.” This is not, however, the same as being productive. By taking the time to concentrate on and embrace block scheduling, we effectively manage the doctor and hygiene schedule laterally. New opportunities to be productive will open up. Distinguish between confining versus non-confining procedures, and determine chairside time versus doctor time to meet production goals.

Another doctor recently shared how he liked to schedule according to what he enjoyed doing in the mornings versus in the afternoons. He said everything is going much smoother in his practice.

Our training helped this doctor see that achieving production goals by a specific time left his afternoons free to focus on relationship building with patients. Not only did it give the hygiene team more freedom to plan production, it opened a dialogue that wasn’t previously there.

Immerse yourself in Total Team Training and Dr. Dick Barnes’ philosophies, and you’ll find many rules and step-by-step instructions for achieving success. Keep in mind that all the courses were developed for immediate implementation. When a team is “in structure,” they truly understand the areas of focus discussed earlier. They implement the tools, verbiage, and principles provided at our training sessions.

What is the structure? It is a skillful strategy based on three areas of focus. They provide principles and essential step-by-step training, leading to a productive and profitable practice. When everyone implements the strategy with exactness, a practice can reach its full potential. This is known as becoming “Barnesified.” It’s an opportunity to reap the rewards of this “so-called mystical show.”

There are no illusions! Knowing the structure and how to follow through, relearn, and apply principles can put your dental practice in a class of its own. Your success is just a few training sessions away.