Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.
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DentalChronicle
Your finances
Fee-based
advisors offer
best value
n Is your advisor fee-based
or on commission? It might
affect the type of financial
advice he or she provides
by Louise Gagnon,
Correspondent, Dental Chronicle
F EE-BASED FINANCIAL ADVISORS ARE
the best choice for dentists to
ensure their own long-term finan-
cial health.
“It’s important to deal with an advi-
sor who doesn’t offer products on com-
mission, and then that way there is more
incentive to be up front and disclose the
costs of everything,” says Imran Syed,
partner and principal with Pallenburg
Wealth Management in Ottawa. “You
want to find someone who is independ-
ent and someone who charges for
advice and not for products. It is better
to deal with someone who does not
have in-house products [to sell].
“How someone gets paid is fun-
damental to the type of advice that
they provide,” said Syed, during a pres-
entation at the annual meeting of the
Ontario Dental Association. “An
insurance agent, for example, would
tell you to buy more insurance.”
COST-SAVINGS WILL ADD UP OVER TIME
It can be restrictive if dentists want to
part ways with an advisor who is work-
ing on a commission basis because the
dentist, as an investor, will have to sell
the financial products to do so. “There
are huge cost savings dealing with a fee-
based advisor, plus there are conflicts of
interest that are avoided,” he says.
Dentists should take advantage of
the benefits of incorporation, such as
the opportunity to establish an individ-
—please turn to page 13
More patients compromised
DENTISTS SHOULD AIM TO PROVIDE CARE
that is suitable for a patient’s health and
mental status, Dr. Trey Petty advised dur-
ing the annual meeing of the Ontario
Dental Association. See page 12.
Canada’s National Newspaper of Dentistry
Affiliated with
Implant fracture and the physical mechanisms for failure ..............19
Three essential lessons for new dentists ..........................................21
10 minutes with Dr. Richard Souviron ..............................................26
Special Repor t
Implants
Veneers 2010
by Louise Gagnon,
Correspondent, Dental Chronicle
A S DENTAL TECHNOLOGY AND TECH-
niques improve, and the quest for
minimally invasive dentistry has
risen to paramount importance for
maintenance of structural integrity and
predictability, a far greater variety of
materials and techniques have become
available to perfect the end results when
placing anterior restorative options such
as veneers, implants, or other ceramic
restorative solutions.
To optimize the outcome of plac-
ing a veneer, Dr. Andrew Shannon, a
Vancouver clinician who is a leader in
cosmetic dentristry in Canada and who
has been accredited by the American
Academy of Cosmetic Dentistry since
1997, says he might first opt for ortho-
dontic treatment of a patient.
“If their teeth are not aligned,
before taking away a lot of tooth struc-
ture, it’s far better to align the teeth, so
the amount of aggression you need to
use is minimized,” says Dr. Shannon.
Dr. Shannon, who has been listed as
one of the Top 100 clinicians by Dentistry
Today for five years running and who has
presented to fellow clinicians at national
and international meetings, says his
approach is to present numerous options
for patients and then discuss the advan-
tages and disadvantages of the options.
“The approach we take may come
down to what are the patient’s clinical
concerns about what is going on in their
n September 30, 2010
NOW: s.
ew
M O R E n es. New this month
ag
MORE p
Products
New Handpieces
The S600NL has a standard-sized
head to allow easy, comfortable access
to the mouth posterior, the S700NL
has a torque head for greater power.
Scaling Adjunct
Arestin (minocycline
hydrochloride)
microspheres decrease
pocket depth in adult
patients with chronic periodontitis.
© Pascal Eisenschmidt | Dreamstime
and Picasso, Picasso Lite Lasers
in
Perfect for a first laser
or for advanced laser
experts, the Picasso
series performs a wide
range of procedures.
Ultrasonic Scaler
mouth,” he says. “There are many ways Ergonomic grip designs in hard and
to achieve the end result. The treatment soft styles, with a wide variety of tip
plan may consist, for example, of styles available in both 25K and 30K
crowns in conjunction with veneers, in
conjunction with bleaching.”
When placing implants, it is impor-
tant to consider the factors that increase
frequency options.
Request more information on these and
other products advertised in this issue.
the likelihood of implant failure, such as See page 25
heavy smoking or bisphosphonate ther-
apy, adds Dr. Shannon.
Special Report
FOUR GOLDEN RULES
Dr. Ron Goodlin, a Toronto dentist who What you need to know
is also accredited with the American
Academy of Cosmetic Dentistry and is about managing water,
the Clinical Director of Education at the
Canadian Institute for Cosmetic Dental amalgam separation
Education, presented a talk recently on NEW, EFFICIENT UNITS FOR WATERLESS
minimally invasive placement of veneers, vacuum and amalgam separation can
noting prepless and minimal prep save you money, and help the environ-
—please turn to page 8 ment as well. Turn to page 15
DentalVitae
Dentist leads drag race team with Funny
Car that runs 405 km/h in the 1/4 mile
Dr. Brian Friesen of Winnipeg says his all-volunteer
team competes with the sport’s big guns. See page 24.
Canada Post Canadian Publication Sales Product Agreement 40016917
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:35 PM Page 2

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Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:35 PM Page 3

Attending the Thompson Okanagan Dental Society AGM in Kelowna, B.C.? 2

We’d love to receive your impressions of the presentations and session highlights.
E-mail us at dental@chronicle.ws
Have a digital photograph of an upcoming meeting destination? Send it to us at dental@chronicle.ws.
We’ll publish selected photos and reward photographers with gift-card prizes.

American Academy of Craniofacial

Dental Chronicle National Editorial Board Pain, Canadian Chapter 4th Annual
International Symposium
15 to 16 October, 2010
Each issue, Dental Chronicle is honored to introduce you to the distinguished members of our
Toronto
National Editorial Board. This month, we welcome Dr. Scott Maclean of Halifax.
Tel: 519-435-0438
Email: aacpcanada@connectdot.ca
Hassan Adam, DR. SCOTT MACLEAN’S DEDICATION TO HIS PROFESSION Website: www.aacpcanada.ca
Yellowknife, N.W.T. emerges through the many hours he spends learning
Véronique Benhamou, and teaching his art. Thompson Okanagan Dental Society—
Montreal, Que. “I travel a lot to train, to train myself to make my Annual General Meeting, Conference
skills the best that they can be and so that I can train 28 to 30 October, 2010
Barry Dolman, others and do some lecturing and keep in touch with Kelowna, BC
Montreal, Que. other people,” Dr. Maclean says. Tel: 250-832-2811
It’s also clear to anyone who was seen him interact Fax: 250-832-2811
Neil Gajjar, Mississauga, Ont.
with his patients. Email: tods@sunwave.net
Cary Galler, Toronto, Ont. “When they get out of the chair and give you a hug
out of pure appreciation, it makes you feel that you’re doing a great job for them.,” Toronto Academy of Dentistry 73rd
Wayne Halstrom,
said Dr. Maclean, or as his patients call him, Dr. Scott. Annual Winter Clinic 2010
Vancouver, B.C. 12 November, 2010
He believes in treating the entire patient, he said, not just their mouths or teeth,
Mel Hawkins, Toronto, Ont. a belief he said came from his mentor, Dr. Carl Dexter, a dentist for fifty years. Toronto
Dr. Maclean said Dr. Dexter had a “robust practice,” which Dr. Maclean Tel: 416-967-5649
Ira Hoffman, Fax: 416-967-5081
Chomedey, Laval, Que. learned first hand when he substituted there for another dentist.
E-mail: admin@tordent.com
“[Dr. Dexter’s practice] was based on treating people not mouths, and not
Mark Lin, Toronto, Ont. Website: http://www.tordent.com
teeth,” he said. “He was a great mentor in terms of professional development,
Ed Lowe, Vancouver, B.C. believing that you need to be teaching, believing that you need to be learning.”
Northeastern Society of Orthodontists
The last of these lessons Dr. Maclean seized with gusto, as he not only teach-
Scott Maclean, es patients, but also teaches dentistry at Dalhousie University in Halifax.
(NESO) Annual Meeting
Halifax, N.S. 11 to 14 November, 2010
He said that in teaching, he learns much from his students. Montreal
John Nasedkin, “I think it keeps you sharp. Some of the students ask the best questions of the Tel: 301-718-6510
Vancouver, B.C. profession,” said Dr. Maclean. “They have different views, because they’re not in a Fax: 301-656-0989
paradigm of thinking that dentistry is one way.” Email: neso@paimgmt.com
Ken Neuman, Bone grafting and surgical placement of implants are what he’s learning now in Website: www.neso.org
Vancouver, B.C. his continuing education couses, he said. “That’s my primary focus, surgical place-
Brian Saby, Red Deer, Alta. ment of implants and working with cadavers, and trying to advance my hand skills
NOW: s.
ew
M O R E n es.
to the highest level I can.”
Ken Serota, Mississauga, Ont. Dr. Maclean said activities outside of his education has benefited his practice.
ag
Paresh Shah, Winnipeg, Man. One of these activities is football, for which he was inducted into Acadia
University’s hall of fame during his undergraduate career.
MORE p
Andrew Shannon, “It taught me a lot,” he said. “You may be the best dentist in the world, but
Vancouver, B.C. when you drop the ball [patients] don’t see you in that way. They see you as what- It may have reached your attention
Howard Tenenbaum, ever limitations you had on that particular day.” that while other dental publications are
At home, Dr. Maclean spends time with his wife, Cindy, and his three children: scaling back, and publishing smaller edi-
Toronto, Ont.
Alex, 18; Haley, 16;, and Emma, 13. “My business practice is really a second family. tions, Dental Chronicle continues to grow
William E. Turner, But my family’s number one,” he said. and expand, and offer you an improved
Thunder Bay, Ont. “I always make sure there’s enough time in my life to go to games, and be and more useful information package.
involved with the number one people in your life.” Thank you for noticing, and for contribut-
ing to our success through your support.

Published six times annually by the proprietor, Chronicle

DentalChronicle
Information Resources Ltd., from offices at 555
Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3
Canada. Telephone: 416.916.2476; Fax 416.352.6199.
Canada’s National Newspaper of Dentistry E-mail: dental@chronicle.ws
PUBLISHER Contents © Chronicle Information Resources Ltd, 2010, except where noted. All rights
reserved worldwide. The Publisher prohibits reproduction in any form, including print, broadcast,
Mitchell Shannon and electronic, without written permission. Printed in Canada.
EDITORIAL DIRECTOR SALES & MARKETING Subscriptions: $59.95 per year in Canada, $79.95 per year in all other countries, in Canadian or US
R. Allan Ryan Henry Roberts funds. Single copies: $7.95 per issue. Subscriptions and single copies are subject to 5% GST.
SENIOR ASSOCIATE EDITOR Phil Diamond Chronicle Information Resources Ltd. is the official representative of Dental Tribune International
Lynn Bradshaw PRODUCTION & CIRCULATION (DTI) in Canada. All published material related to Dental Tribune is subject to copyright by DTI.
ASSISTANT EDITOR Cathy Dusome Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917. Please
Josh Long COMPTROLLER forward all correspondence on circulation matters to: Circulation Manager, Dental Chronicle,
Rose Arciero 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada.
E-mail: circulation@chronicle.ca ISSN 1916-0437

Since 1995, Ideas in the Service of Medicine. Publishers of: The Chronicle of Skin & Allergy, The Chronicle of Neurology & Psychiatry, The Chronicle of Urology & Sexual Medicine,
The Chronicle of Healthcare Marketing, Drug Rep Chronicle, Best Practices Chronicle, healthminute.tv, and Linacre’s Books.

DentalChronicle September 30, 2010 n 3

Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:35 PM Page 4

ClinicalNews
agree
The Dental Chronicle Buyer’s Guide: Dental lasers available in Canada patie
n Advances in laser technology means the units are becoming more useful for both hard and soft tissues, and more affordable affor
also
patient in-house with the relatively inex- outlet.

L
ASERS THAT ONCE COST $50,000 AND COULD ONLY BE risk o
pensive Picasso Lite laser. patie
used for specific approved indications are now much Dr. van As said there are many pro- Ivoclar Vivadent—Odyssey Lasers
cedures that are made significantly easier Ivoclar Vivadent offers two diode lasers. tem
more affordable and can be employed to accomplish a by the Picasso The Odyssey Navigator weighs 1.12 kg ditio
variety of preventive, cosmetic, and surgical treatments for Lite laser. and features a touch screen monitor, a used
“The laser highly rated design and navigation abili-
your patients, on both soft and hard tissues. In addition to can be used to ty, and a screen that can be inverted.
for m

being much kinder to the practice pocketbook, lasers are reduce the com- There’s room for eight user-defined pro- py,”
now small enough to fit on a tray table so they can be easi- plexity, to get the grams, and there’s no need to cleave or poin
soft tissue out of strip fiber from this laser after each use, every
ly transported to different examining rooms. In fact, some Dr. van As the way and then as dentists can just snap on a new tip. You
of the new lasers can even fit into your pocket. allow you to con- The 2.25 kg Odyssey 2.4G laser has an instr
tinue on with your task,” said Dr. van As. LED display, an aiming beam to help root
The following Laser Buyer’s Guide, assembled by the “But there are procedures that the den- place the laser, and allows for three user
editors of DENTAL CHRONICLE, outlines the main features defined programs. bacte
right
of most of the lasers available to Canadian dental practi- Periowave PW1100 of ti
tioners, as of press time. “Not all lasers are cutting lasers,” noted outc
Dr. Cary Galler, describing the Perio- men
Please check out our online laser survey at wave PW1100 disinfecting laser.
http://ow.ly/2IoD9. We’d welcome the opportunity to “When people talk about lasers,
generally they think about cutting,
hear your comments regarding experiences with lasers in because that is what a laser does—this is
your practice, and we’ll publish a report based on reader a non-cutting laser,” said Dr. Galler, a
periodontal specialist in Toronto who
responses in an upcoming issue. Additional comments can uses the Periowave PW1100 in his prac-
be emailed to health@chronicle.org Picasso tice to eliminate pockets of bacteria and
Dr.
improve the outcomes of periodontal
The Picasso and Picasso Lite from “It’s a unit you can easily carry from therapy.
AMD LASERS, distributed in Canada room to room.” Instead, the Periowave PW1100
by Oral Science Assembly is also easy, said Dr. van activates a specialized methylene blue-
At $2,995, the affordability of the As. “A dental practice can easily incorpo- based solution that penetrates the pock-
Picasso Lite diode laser makes it an rate one of these in a very short period ets and stains residual bacteria. Dr.
attractive option for dentists, said Dr. of time,” he said. “I always laugh, it can Galler then uses the Periowave PW1100,
Glenn van As, who operates Canyon take a certified dental assistant 10 to 15 a red laser, to activate the methylene blue
Dental Centre in North Vancouver. minutes to put it together for you. It solution and kill bacteria in the pockets Dr. B
“Its elegance and simplicity have would probably take the dentist half an via singlet oxygen formation. The
brought many new users into the laser hour. But it’s easy enough to put togeth- process leaves behind a balance of said
dental field in the last year or two,” he er, and there’s a quick install DVD.” Gram-positive bacteria which are respo
said. The Picasso Lite pays for itself, said required for establishment of good peri-
Dr. van As said the laser is easy to Daniel Ménard, president of Oral Picasso Lite
odontal health.
use, primarily because of its small size. Science, the company that distributes the tist may not want to use because they Dr. Galler said reducing the number
“One of the interesting things is Picasso lasers in Canada. involve suturing or a chance of bleeding, of pathogenic bacteria prevents the pro-
that in the past a laser was made multi-op He said the Picasso Lite allows den- but that can be now completed by the gression of disease, and the Periowave
by putting it on a cart, and carrying the tists to keep patients within their prac- average general dentist using the laser.” process is able to painlessly reach and kill
laser between laboratories,” said Dr. van tice, rather than having to refer them to He said the Picasso provides a solu- these bacteria in deep pockets.
As, who said this strategy was necessary other dentists. tion that is ideal for everyone involved. “You can do this in an environment
for lasers that were too difficult to carry “There are biopsies, for example. A Per
“It’s going to be a win-win situation for when the pocket is deeper because the
around unassisted. That is no longer the lot of dentists are sending [patients who both your patients and your practice,” light penetrates quite deeply into the oral smal
case with the Picasso Lite, Dr. van As require them] elsewhere,” he said, when said Dr. van As. tissues.” optic
said, which weighs in at 0.9 kg. these dentists might easily treat the One of the advantages of the
Softlase Pro laser Periowave disinfection system, Dr. ‘oper
The Softlase Pro diode laser has room Galler said, is that it can serve as an alter- Loeb
for eight preprogrammed settings. native treatment in situations where sur- he re
Procedures can be accessed through a gery is not possible. don’
touch screen that also includes voice “Patients have conceptions on how cord
confirmation to ensure users know what they wish their care to be directed, and [or] a
choice they have selected. At 1.35 kg, it’s they often overrule you,” said Dr. Galler, from
portable enough to be moved anywhere “even though you might explain the ben-
in the office that has access to a 110 volt efits of your treatment, they may not were

DentalChronicle
 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:35 PM Page 5

agree with you.” Periowave HHL-1000 provided them ordinary battery charger. The laser is very light, very convenient to
Dr. Galler said that can happen if a another option in the form of a cordless Dr. Veronique Benhamou, the use,” said Dr. Benhamou.
patient is afraid of surgery, or cannot laser the size of a pen. director of periodontology at McGill She also said this system allowed
afford the procedure. He said there are “They loved it,” said Dr. Loebel. University, has had the opportunity to her to effectively treat deeper pockets
also medical conditions that increase the “They said, ‘gotta have it.’ They all pre- use the HHL-1000 at her own practice. than with regular therapy, and that there
risk of surgery, such as diabetes or if the ferred it over the base station format.” “I think it’s great, with the same was less bleeding when she probed after
patient is on blood thinners. He also noted the HHL-1000 laser can outcomes as the earlier model laser. The the healing phase. She also found a
Dr. Galler said the disinfection sys- be used with rechargeable AAA batter- differences are that I don’t have as much decrease in inflammation and less reces-
asers. tem works well in conjunction with tra- ies, which can be charged using the clutter. I don’t have a foot pedal to deal sion of soft tissue, and she said these
2 kg ditional treatments, but shouldn’t be charger included with the kit, or by any with, and I don’t have wire to deal with. —please turn to page 23
or, a used for all patients nor as a replacement
abili- for mechanical cleaning.
ith
rted. “It’s not approved for monothera- Now w d
ve
pro- py,” he said. “And that’s an important impro y!
sit
ve or point, so you don’t just squirt the laser visco
use, everywhere and send the patient home.
w tip. You still have to do the mechanical Introducing the
as an instrumentation,” including scaling and
help
user
root cleaning.
“I strongly believe that this does kill
bacteria when it’s used properly in the
Periowave™ HHL-1000
oted
right concentration with the right period
of time, and that produces better clinical
outcomes,” he said. “It’s painless treat-
Photodisinfection System
erio- ment.”
Dr. Galler said
sers, he uses the Perio-
7KH++/PDNHVLWHDVLHUWKDQHYHUWREHQH¿W
ting, wave PW1100 laser, from the Periowave™ Photodisinfection System.
his is though a new model
er, a has been developed,
who the Periowave HHL-
prac- 1000, a laser slightly Non-thermal laser improves patient outcomes
and larger than a pen. It without causing pain
ontal Dr. Galler
was made available
to dentists in Can- Reduces antibiotic usage
1100 ada as of mid-
blue-
ock-
August. Builds your practice and increases revenues
Nick Loebel,
Dr. who holds a PhD in
100,
Empowers your Dental Hygiene department
biomedical engineer-
blue ing and is Ondine
ckets Attracts new patients with the latest technology
Dr. Benhamou Biopharma’s Chief
The Technical Officer,
e of said the HHL-1000 was designed in
are response to clinicians who wanted a
peri- Step 1 Step 2
Irrigate Illuminate
mber
pro-
wave
d kill

ment
Periowave
e the
oral smaller laser unencumbered by fiber
optic cables and power cords.
the “You still have clinicians who say,
Dr. ‘operatory space is limited,’” said Dr.
alter- Loebel, quoting some of the feedback
sur- he received from dentists, “'and they also
don’t like the fact that there’s a power Learn more about Periowave™
how cord involved when you’re charging it,
and [or] a fiber optic cable that transfers light www.periowave.com
aller, from the station to the handpiece.”
ben-
info@periowave.com 1.866.669.0555
Generally, Dr. Loebel said, dentists
not were willing to accept this, until the

icle
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 6

ClinicalNews 

Picasso and Picasso Lite lasers now available to Canadian clinicians B+
5;4)
/5
n Picasso dental lasers have proven that laser dentistry has finally arrived in the industry, says laser company president +>)2
The Picasso series of lasers, distributed interview, AMD LASERS President recent launch in Canada. were too complicated and too costly. 3'
AMD LASERS has made lasers afford- :/54
in Canada by Oral Science, were and CEO Alan Miller spoke to Dr. Why lasers? Why now? :53+
able for the general practice, and they are
developed by AMD LASERS of George Freedman regarding the devel- Great question! 2010 represents 50 years rapidly becoming the standard of dental +,,+)
Indianapolis, Ind. In this exclusive opment of the Picasso laser and its of lasers. But for most dentists, lasers treatment. Patients 5,
are educated and +92
know that lasers +8
are the standard of ':/54
care (take eye sur- 

*'9#+6+5(+0#..;18'4^ gery for example),

and they expect
their dentist to Dr. Freedman
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have the same

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matter of supply
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patient wants laser 2/::2+
therapy, dentists 254-
can use lasers easi- Alan Miller ?5;
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 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 7





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Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 8
ClinicalNews
Implants and veneers in 2010: More methods available to perfect results
continued from page 1—
veneers can be a welcome addition to a
patient treatment plan.
“The patient’s concerns are often
that they don’t like the idea of cutting
into the tooth,” he said. “If we can min-
imize the amount of cutting into the
tooth, that can be critical to the ultimate
success of the case by improving the
structural integrity of the tooth as well
as the bond strength of the ceramic to
the underlying tooth, and it makes it eas-
ier for the patient to accept treatment.”
He sees four golden rules involved
with the placement of veneers, with
those being first to avoid cutting into the
tooth unless absolutely necessary. If cli-
nicians do need to cut into the teeth, they
should minimize the amount, because
the more they cut, the more tooth struc-
ture is removed, and the more they com-
promise the structural integrity of the
tooth. Secondly, clinicians should aim to
maximize the amount of enamel that the
veneers can bond to. Although clinicians
can bond veneers to dentin, bonding to
enamel is preferable because it provides
for a stronger bond. “The veneer will be
stronger if they bond to enamel,” he says.
The third golden rule is to start with
the end in mind. Do a mock-up of where
the ideal tooth position should be follow-
ing the principles of smile design (espe-
cially when determining the all-important
incisal edge position). Once the ideal
position is determined, the clinician can
decide on the most minimally invasive
approach to achieve the desired outcome.
The fourth golden rule is that the
occlusion has to be correct, says Dr.
Goodlin. By starting with a diagnostic
wax-up or composite mock-up before
the teeth are prepped, the clinician has
the ability to transfer the architectural
model to the patient’s mouth in the form
of a temporary mock-up, allowing the
patient to take the new smile for a test
drive and work out the cosmetic and
functional issues, thereby making sure
your patient is happy and comfortable
every time,” he explained.
EACH CASE HAS MANY ANGLES
Dr. Goodlin agrees with Dr. Shannon that
performing orthodontic treatment before
the case is started is the preferable way to
ensure that any teeth that are not very well
positioned are better positioned so as be
able to minimize or eliminate the loss of
tooth structure. Performing teeth whiten-
ing before the teeth are prepped will con-
tribute to an esthetically desirable out-
8 n September 30, 2010
come to make certain the tooth color
showing through the veneer is correct.
In some situations, where clinicians
have sufficient tooth to work with, they
can use traditional feldspathic porcelains
as well as a pressed
ceramic, such as
the E.max materi-
al. Dr. Goodlin
uses a cutback
technique on the
porcelain itself
and layers in some Dr. Shannon
different surface
porcelains to create a more “lifelike”
appearance. Additionally, he uses incisal
translucencies and proper color gradation
along with nuances of maverick colors
and characterizations to give his restora-
tions a natural yet esthetic appearance.
“The problem is that very often cli-
nicians view a case as a ‘veneer case’ or a
‘crown case’ or a ‘bonding case’, like see-
ing apples and oranges, whereas compre-
hensive treatment is more akin to a bowl
of fruit,” he says. “One tooth is an apple,
another is an orange, and another is a
banana. We can minimize oss of tooth
structure and the amount of financial
cost to the patient by combining differ-
ent techniques such as minor orthodon-
tics and then using a composite on one
tooth with a veneer on another.”
Newer materials such as Empress
Direct from Ivoclar allow dentists to
accomplish these goals because the com-
posite material mimics the optical and
physical properties of the ceramic. “The
polish, wearability, strength, color match,
and longevity of these restorations are
outstanding, making them last longer and
more resistant to stain,” Dr. Goodlin adds.
“When you have one next to the
other, they look the same,” he says.
“Rather than placing eight veneers, you
may only need to place three veneers and
a few composites. Fewer teeth need to be
reduced, it is less invasive, and it can pro-
vide a more responsible esthetic solution.”
Incisal Edge Position and the correct
anterior guidance needs to be ensured, so
that the envelope of function is not
inhibited, to reduce the risk of breakage
of these restorations, and it increases
durability and comfort, adds Dr. Goodlin.
Dr. Lancelot Brown, a Toronto den-
tal surgeon, is increasingly placing more
veneers. Although he agrees with the prin-
ciples (the four Golden Rules) advanced
by Dr. Goodlin), in his experience,
patients do not report the same comfort
level with “no-prep” or prepless veneers
as they do with veneers that require
preparation. “These teeth feel thicker for
patients,” he says.
He has found that prepless veneers
can fail from their inherent thinness, and
require repair or
replacement more
often than veneers
that require prepa-
ration.
While com-
posite bonding as
Dr. Br own veneers is less
expensive than
porcelain veneers, the porcelain veneer
will last much longer.
“Composite material is nowhere
near as durable,” he says, noting compos-
ite restorations last about four to six years.
“The incidence of discoloration is
also much higher with composite bond-
ing and is very much dependent on a
patient’s social habits. If you are a smok-
er or drink a lot of coffee or tea, you
may find the color of the restorations
will fade more quickly.”
IMPLANTS HAVE COMPETITIVE PRICING
Porcelain restorations last about 12 to 15
years, and the quality of the porcelain,
such as those made from lithium disili-
cate, have improved to the point that
“you’d be hard-pressed to know that it
wasn’t the person’s natural tooth.”
There is less need to replace porce-
lain restorations over time than com-
posite restorations, and therefore they
are more cost-effective in the long run,
according to Dr. Brown.
David Kochberg, RDT, one of the
founders of the Toronto Implant and
Aesthetic Study Club, operating manager
of Applied Arts Laboratories Ltd., says
that while anyone who loses a tooth is a
good candidate for a dental implant,
there are several issues in determining
the viability of a dental implant.
“Sometimes it’s a financial consider-
ation, and sometimes it’s an anatomical
consideration, and bone is not there,”
says Kochberg, who runs the Academy
of Dental Technology in Toronto. There
are constant changes in terms of pros-
thetics regarding implants, he notes.
Cone-beam computed tomography
is used to capture a scan and produce a
model of the jawbone, and clinicians
develop a surgical guide for patients,
explains Dr. Robert Leigh, who runs the
Implant Smile Center of Alberta in
Westlock, about 90 minutes north of
Edmonton. The guide is inserted into the
mouth and screwed into the jawbone.
MANY SHAPES AND SIZES AVAILABLE
“Once the surgical guide is screwed in,
we can then go about placing the
implants into absolutely perfect posi-
tions,” says Dr. Leigh, a diplomate of the
American Board of Oral Implantology.
“If they are placed any old way, there
may be difficulties with angulation,”
which may ultimately compromise the
esthetic and functional results.
Many more companies are now offer-
ing implants, making the pricing very com-
petitive, says Dr. Leigh, whose patients
come from all over North America.
“For $200 to $300, you can get a top-
notch implant,” he says. “You do not need
to charge $3,000 to place an implant.”
The prosthetic component, the
abutments of the implants, are now
available in many different shapes and
sizes, as well as more esthetic materials
such as custom made Zirconium abut-
ments with the margins already pre-
pared, Dr. Leigh said, and they can be
ordered at different angles as required,
or as longer or shorter or fatter versions.
“They have impression transfer
copings that we can snap onto the abut-
ments in the mouth and transfer that
information to a master case,” Dr. Leigh
says. “It helps to make our impression-
taking that much easier.”
Computer-scanned impressions will
increase the precision of the procedure,
such that the information can be emailed
to a computer and the laboratory can make
the crown without seeing the patient.
One of the other advances in implant
dentistry, apart from computer usage to
assist in the precise placement of implants,
is the availability of new materials for bone
grafting, materials that include cadaveric
bone and synthetic bone, allowing more
patients to be eligible for implants follow-
ing the grafting procedure.
“We can cause bone to regrow,” Dr.
Leigh notes, adding that hormonal ther-
apies allow for regrowth of bone. “We
can graft from other sites of the body,
such as the hip and the knee, and move
it to sites in the mouth.
“Oral surgeons can do some of
these procedures in patients who have
severe bone atrophy. When there is a big
graft involved, we refer the case to an
oral surgeon.”
Implantology is a field that is well-
suited to general dentists, and it is a field
that is driven by prosthetics, says Dr.
Leigh. 1
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1. GSK data on file, 2010. 2. GSK data on file. Sensodyne iso-active® claim support summary, Jan. 28, 2009. 3. Leight RS et al. Dentinal hypersensitivity:
a 12-week study of a novel dentifrice delivery system comparing different brushing times and assessing the efficacy for hard-to-reach molar teeth. J Clin
Dent 2008;19:147–153. 4. Gross RC et al. Removal of oral debris/bacteria by an experimental gel-to-foam toothpaste. Presented at the General Session
icle and Exhibition of the Pan European Federation of the International Association for Dental Research 2008, September 10–12. London, England. Poster 467.
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 10

ClinicalNews
Dental grey market: Products could be compromised in safety, efficacy Th
n If chain of custody of products cannot be established, dental practitioners could be placing themselves in legal jeopardy nD
Dental products that are sold in market for dental products and more the time they make it to North Am-

D ENTISTS NEED TO EDUCATE THEM-

Gord
Canada need to be compliant with education is needed to inform them that erica.” prosth
selves to ensure they are providing
Medical Devices Regulations as out- it is in their best interest to steer clear of Dr. Boccia further states that: “Today Pract
their patients with licensed prod-
lined by Health Canada. Sales represen- ordering and using grey market prod- we have some countries which are dupli-
ucts that are aimed for the marketplace
tatives from licensed firms that sell den- ucts. cating the containers and wrappings of
in Canada.
tal devices and dental materials in “You hold the risk of liability tied to many intra-oral dental products [grey to
There’s a burgeoning “grey market”
Canada should be able to provide evi- the fact that you use grey market prod- black market products] so accurately that
in Canada where dental products and
dence of compliance whenever dental ucts,” says Jugoon, noting that grey mar- even the legitimate manufacturer cannot
devices that may not be authorized by
practitioners request that information. ket products may be compromised in distinguish them from their own. We have
Health Canada are being distributed
If manufac- terms of safety and efficacy. found much inferior products in these
through unlicensed channels. Using such
turers choose to It may be that the products are not duplicated containers with no proven qual- Dr.
products can potentially place dental
work with a dis- compromised when they reach the end ity control. The dentist finds these inferior
practitioners in legal hot water if they
tributor, manufac- user in Canada. Still, the sale of grey products difficult to work with intra-orally and h
prove to be compromised, observes
turers produce market products is illegal because the and potentially harmful to the patient.” Chris
Bernie Teitelbaum, executive director of
guidelines for chain of custody cannot be established, Dental practitioners should exercise regard
the Dental Industry Association of
their distributors stresses Jugoon. Dentists who buy grey caution if they are being promised deals that a
Canada (DIAC).
to adhere to, in market products incur all the potential on products or dental materials that adopt
Since manufacturers are required by Ju g o o n types
order to ensure costs associated with them and could sound too good to be true.
Health Canada to ensure that shipping, count
that goods are face reprimands from their provincial “If you are buying products after
storage, and handling of their licensed Louis
shipped, stored, licensing body if it is proven that they you saw a flyer that reached your
products is in compliance with their
and handled in a have not exercised a professional stan- doorstep, then it is a case of buyer
published requirements, they will not Is it y
manner that guar- dard of care, adds Jugoon. beware,” says Dr. Boccia.
warranty any product that is sold tenc
antees product Even though dental practices are Indeed, dental practitioners who are
through a distribution channel that they Cana
efficacy and safe- excempt from medical device regulari- seeking “bargains” when they are pur-
can’t control. This leaves the dentist to They
ty. ons [as healthcare facilities], they are not chasing dental materials and devices may prod
assume the entire risk.
“Some den- Dr. Boccia exempt from their own professional be avoiding the costs of regulatory com- barg
When dentists use licensed prod-
tists say they will standards of care in their choice of den- pliance in Canada. exce
ucts obtained through licensed and
not touch grey market products because if tal materials. “The dentist is ultimately responsi- has m
authorized distributors, those products
someone [a patient] gets hurt [because of Manufacturers are being encouraged ble for the treatment of their patients,” grey-
can be easily traced back to the manufac-
the use of such products], it will damage to make potential grey market product stresses Dr. Boccia.
turer for recourse or recall, and a dentist
the credibility of the dental community,” more identifiable for dentists, including Wha
can rely on the manufacturer to back
says Teitelbaum. “It is just not worth the rebranding and repackaging products that EDUCATING STAFF A GOOD IDEA dent
him up, explains Teitelbaum.
risk of patient complaints, remakes, and are now being diverted in unknown con- Dentists need to educate themselves and Ther
recalls to save a small percentage of a ditions from third world markets. their staff about the availability of grey expir
EVIDENCE OF COMPLIANCE
small percentage of the dentist’s total Dr. Aldo Boccia, a Toronto dentist, market products and to be watchful if be c
“The dentist took care to ensure the
costs.” says Canadian dentists are bombarded they are conducting electronic business beca
product was licensed and safe,” says
Peter Jugoon, Vice-President of with advertising, in the form of flyers and purchasing products online, accord- ure m
Teitelbaum, noting that the same legal
Marketing and Strategic Planning for and catalogues, which boast of substan- ing to Teitelbaum. roun
protection may not exist if dentists are
Henry Schein Canada and past-presi- tial savings that dentists can make when “Dentists are usually not the ones appr
using unlicensed products or products
dent of DIAC, says many Canadian purchasing dental products and devices. placing the order,” says Teitelbaum. trace
distributed through unlicensed channels.
dentists are not aware that there is a grey “They are usually not the ones who are
PRODUCTS FOR USE IN OTHER MARKETS receiving the order, and they are usually expo
A recent e-mail survey conducted among over 100 dental clinicians who read DENTAL Dr. Boccia speculates that these are not the ones who are opening up the its in
CHRONICLE seems to indicate that the majority are aware the grey market is operating in products that were legitimately manufac- box. The dentists should ensure they have
tured for countries in Eastern Europe or tell the members of their staff not to er if
Canada, with 73 per cent of respondents indicating in the affirmative when asked if they
dentists in developing countries, for ‘do them any favors’ by searching for sale.
knew about the grey market.
example, and they have been rerouted to bargains on dental materials and prod- grey-
Although there is an approximately even split between dentists who personally
verify that the dental products and devices they purchase are covered by a Canadian North America and sold at a lower cost ucts.”
compared to products originally Health Canada does not have suffi- Wha
medical device license and those who don’t, dental practices are being careful with Den
designed for North America and cient resources to monitor that all mate-
their purchases—87 per cent of the survey respondents claim that they have never deter
Western Europe. rials and products being used in dental
purchased any dental products or devices that they later found out might have been price
“They [grey market products] are practices are covered by a Canadian
grey market products. This figure may be a testament to a more concerted effort by of m
making their way into North America, medical device license, a license that is
sales reps to ensure that the products they sell have appropriate licenses, as 87 per clue
but they were destined for other mar- obligatory for the legal sale of medical
cent of the responding dentists report that is how they purchase dental products—from pack
kets,” explains Dr. Boccia. “They may and dental goods in Canada, according being
sales reps. be good products, and the quality may to Teitelbaum.
DENTAL CHRONICLE periodically polls its readers on matters relating to the practice of smea
be there. However, they were designed An official from Health Canada expir
dentistry and the publication. If you would like to participate in future DENTAL CHRONICLE for and shipped to different markets. declined to comment on the availability
surveys, please send an email with the subject line “Yes to survey” to We do not know if there have been any of grey market products to the dental mark
cathy.dusome@chronicle.ca. Our surveys are quick, and easy to complete. degenerative effects on the products by community in Canada. U.S.

10 n September 30, 2010 DentalChronicle De

 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 11

The dental grey market can be dangerous to your career, U.S. dentist says
n Dentists should meet with staff member who manages supplies to establish the product brands and quantities to be ordered
Am- Gordon J. Christensen, DDS, MSD, PhD, a practicing How can dental staff, who usually order products, be Would different packaging make it easier to identify
prosthodontist in Provo, Utah, is founder and director of educated about grey market dental products? grey market dental products?
Today Practical Clinical Courses, an international organization dedi- Dentists should meet with the staff member in their Yes, it would.
dupli- cated to continuing education for den- office who orders supplies in order to evaluate the
gs of tal professionals, and Dean of the office’s supply needs and establish the brands and What advice would you give to dentists to help them
ey to Scottsdale Center for Dentistry. Dr. quantities that should be ordered. avoid the potential purchase of grey market and coun-
that Christensen assisted in developing den- It would help to identify unauthorized distributors terfeit products?
nnot tal schools at both the University of of products. I think it is a wise decision to deal with major distribu-
have Kentucky and the University of tors. Such distributors also provide repair support. I
these Colorado early in his career. He has How do you suggest manufacturers ensure their prod- can also discuss the qualities of the products with local
qual- presented more than 45,000 hours of ucts are not sold as grey market dental products? sales representatives.
Dr. Christensen
erior continuing education across the globe Dental manufacturers are starting to use labelling to Dentists should also steer clear of heavily dis-
orally and has numerous published articles and books. Dr. allow for identification of grey market and counterfeit counted prices. They should expect to pay a fair market
.” Christensen has become active in educating his dental peers products. One manufacturer has filed a citizen peti- price for products, with price reductions not being very
rcise regarding the perils of the “grey market” for dental products tion with the Food and Drug Administration in the great or frequent. Dentists should ask themselves how
that are available to North American dentists. He advocates U.S., seeking action against authorized dealers that dental retailers can sell dental supplies at highly dis-
deals
adopting a “buyer-beware” approach when it comes to these have been discovered to be distributing grey market or counted prices while other retailers sell the same sup-
that
types of products that are being offerred, often at steep dis- counterfeit products. It is unknown what percentage plies at market level.
counts. He spoke with DENTAL CHRONICLE contributor of dental products sold are counterfeit or grey market It is best to adopt a buyer-beware policy in dental
after
Louise Gagnon. products. offices.
your
buyer
Is it your sense that dentists are aware of the exis-
tence of a “grey market” for dental products in
o are Worldwide developments in dentistry
Canada and in the U.S.?
pur-
They may be using grey market or even counterfeit little difference was seen in the
may products, and they may not know it. Many people want AUSTRALIA Conventional wisdom wins again, as a
com- study out of the Australian Research Centre for referring dentists perceptions of
bargains, and dentists who order products are not general anesthesia or IV sedation.
exceptions to this. The widespread use of the Internet Population Oral Health has linked a lack of
onsi- has made it much easier for distributors to try and sell fruits and vegetables to inadequate dentition, USA A study out of the Journal of the American Dental
nts,” grey-market products. according to a report in the Australian Dental Association (2010; 141(4):415-422) compared the
Journal (2010; 55(2):143-149). The results found effectiveness of mouthwash in preventing bacte-
What do you see as the dangers of using grey market those who consume fruits and vegetables less ria present in patients’ mouths from contaminat-
dental products? than once a month had a higher incidence of ing the dental clinic. The study compared a com-
and There are many dangers. The products might be lost teeth. The findings came from data collect- mercial preprocedural mouthwash containing
grey expired, modified, or they may not be the real thing and ed between 2004 and 2006 using a three stage 0.05 per cent cetylpyridinium chloride (CPC) to
ul if be counterfeit. They may have been compromised stratified cluster sample including a computer a rinse solution containing 0.12 per cent
iness because of improper shipping or storage. Material fail- assisted telephone interview, an oral examina- chlorhexidine (CHX) and water to evaluate how
cord- ure may occur. There is the issue of legal liability sur- tion, and a mailed questionnaire followed by a effective they were at reducing levels and com-
rounding the use of dental material that is not food frequency questionnaire. Out of the position of bacteria in oral splatter. The study
ones approved for sale in the U.S. or Canada or cannot be 14,123 respondents, 5,505 agreed to undergo an found that while the water was less effective at
aum. traced back to the manufacturer. oral epidemiological examination. The study eliminating bacteria, CPC was about as effective
o are In addition, the grey market creates a clinical risk was conducted by David Brennan, an associate as CHX.
ually exposure for dentists. When the product does not meet professor at the University of Adelaide.
p the its intended purpose, who can you address? If patients BRAZIL A meta-study is seeking to “systematically
they have complaints, you cannot go back to the manufactur- UK Trouble treating younger patients? An article in assess the factors influencing tooth loss during
er if the product cannot be traced back to the origin of the British Dental Journal asks: what happens if long term periodontal maintenance,” said an arti-
ot to
sale. It is not worth trying to save money by purchasing you put them to sleep? (June 12, 2010; cle in the Pediatric Dental Journal (2010; 20(1):1-6).
g for
grey-market products if there are so many concerns. 208(11):E21). The study set out to “determine Studies including patients with periodontitis who
rod-
which services dentists use to manage unco- underwent periodontal therapy and a mainte-
What are the clues that a product may be grey market? operative children.” To answer the question, nance care program were searched in CEN-
uffi-
Dentists need to look at the price of the products and the study looked at patient and referrer satis- TRAL, MEDLINE, and EMBASE were
mate-
determine if they are significantly lower than market faction of about 400 patients ages five to 12 searched up to and including Sept. 2009. When
ental
price. They should look at online or printed catalogues years who were referred for cavities and the results were analysed and compared, the
adian
of major dental retailers to compare prices. Another orthodontic extractions. Methods of sedation study did not find any definitive conclusions,
at is
clue is that there is an unknown distributor name. The included a combination of intravenous mida- although it did conclude tha t age, smoking, and
dical
packaging may be a clue as well, such as the bar code zolam/ketamine/fentanyl in 40 per cent of initial tooth prognosis were associated with tooth
rding being blocked out or the printing on the package being cases, and intravenous midazolam/ketamine in loss. The study suggested patients be instructed
smeared. If the product has expired or it appears the 34 per cent. In these patients, 56 per cent of to quit smoking, and continue to see their den-
nada expiration date has been changed, that is another clue. dentists preferred general anesthesia, while 66 tists, and said that further analysis into smoking
bility Look for other signs such as if the product is per cent preferred IV sedation. Most of the frequency and the particular type of periodontitis
ental marked that it is not for sale in the European Union or parents were satisfied with the procedure, and would allow for more accurate evaluations.
U.S. or Canada.

icle DentalChronicle September 30, 2010 n 11

Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 12
ClinicalNews
Demographics: More dental patients likely to be medically compromised
n Aging population means dentists will be providing more geriatric care; ODA speaker stresses importance of treatment plans
D ENTISTS MAY NOT BE ABLE TO PRO-
vide ideal care for their patients
who are medically compromised,
and should aim to provide care that is
suitable for a patient’s health and men-
tal status, particularly as that patient
ages.
“There is an idea that anything less
than an ideal treatment plan is compro-
mised [care],” says Dr. Trey Petty, a
practicing dentist and an associate pro-
fessor of surgery
in the faculty of
medicine at the
University of
Calgary.
“An ideal
treatment plan
Dr. Petty
can in fact make
patients sick and compromise their
medical care. Dental care can be very
invasive because we are injecting things
in the mouth and cutting in the
mouth.”
Delivering a talk during the annual
meeting of the Ontario Dental
Association in Toronto, Dr. Petty noted
the general population is not getting any
younger, and that epidemiological phe-
nomenon will be observed in dental
practices.
w w w . o d a n l a b . c o m
T : 1-888-666-ODAN | 1-800-FAX-ODAN | info@odanlab.com
325, Stillview Ave. | Pointe-Claire, QC, Canada | H9R 2Y6 | www.odanlab.com
With the aging of the population,
dentists will have to be providing geri-
atric care to a greater extent, said Dr.
Petty. “There will be more and more
patients walking through their doors
that are older and medically compro-
mised,” he noted.
IDEAL NOT ALWAYS ACHIEVABLE
Moreover, dental schools need to con-
vey the concept of ‘realistic’ care for an
increasingly older patient population
that may possess multiple co-morbidi-
ties, both physical and mental.
“Dentists need to think about
what is realistic to bring about good
oral health versus what has been the
dental school ideal vision,” explained
Dr. Petty.
If a patient is on anticoagulants
following an event like a heart attack or
stroke, for instance, they likely cannot
withstand invasive treatment such as a
tooth extraction or crowing of a tooth,
explained Dr. Petty.
“The patient could bleed to
death,” stressed Dr. Petty, noting den-
tists need to inform themselves of the
patient’s International Normalized
Ratio before they perform surgery or
scaling.
The Dentist Antibiotic
Fe
contin
ual p
It’s recommended that the INR be Another consideration is that
3.5 or less for scaling to be safely per-
formed, and the general recommenda-
tion is that the INR fall between 2.0
and 2.5 for surgery to be safely per-
patients who are on some pharmaco-
logical therapies are not suitable candi-
dates for receiving anesthesia. “If
patients are taking MAO inhibitors,
incor
lishin
[rath
their
formed. these medications are contraindicated Syed
And because of the move to out- with local anesthetic administration,” are a
patient care in treating cancer patients, said Dr. Petty. plan
some patients may be undergoing Other healthcare providers, such mon
chemotherapy and visit the dentist as nurses and physicians, are not trained
without mentioning their medical care. to look in the mouth and think about ensu
Chemotherapy will affect the patient’s the oral health of a patient, said Dr. ty, cr
ability to heal or for their blood to clot, Petty. “Older patients are typically erage
so procedures such as extraction or underdiagnosed and undertreated in
scaling of the teeth may not be ideal to terms of their oral health.” ity in
perform if patients are undergoing Patients who have conditions expla
chemotherapy, said Dr. Petty. such as dementia or Alzheimer’s dis- ance
“You need to be aware of their ease are not able to communicate with of m
platelet count,” he said. their healthcare providers to ensure insur
they receive appropriate care following
OLDER PATIENTS UNDERDIAGNOSED dental procedures, according to Dr. to en
If patients are undergoing surgery Petty. with
because of oral cancer, it may change In such instances, dentists need to prefe
the anatomy in the mouth, and it is a spell out medication regimens designed form
fact clinicians need to be aware of, to relieve pain for patients, and instruct spou
according to Dr. Petty. healthcare providers at long-term care purp
infor
In addition, if patients are under- facilities, for example, to deliver these
going radiation therapy, there is strong medications to provide symptom relief
PROF
potential that they will have xeostomia, to dental patients.
“If y
which predisposes them to other oral “If a patient has dementia, that
spou
health challenges. patient may express that they are in
them
pain by being in a foul mood,” Dr. Petty
said. ment
“We need to write the prescrip- says
NEW the s
tions, so that nursing staff know how
to deliver the medications. You need to from
keep the language simple for caregivers, accor
whether it is family members or staff at
ing o
a healthcare facility. Nurses and physi-
to no
cians don’t know dental terms or the
tooth-numbering system.”
own
al life
It is worthwhile for dentists to
ensure their staff receive training in
inves
how to transport a patient from a
on th
Listed wheelchair to the dental chair to
on the ficul
Liste d decrease the potential for injury and to
e méd emo
du Qué icamen design the office to facilitate such trans-
bec an ts be im
BC, NB d on port. If patients do not oblige with
, NS an
d NL dental staff in their transport from the
formula inves
ries.
wheelchair to the dental chair, then are n
there may be a re-evaluation of the guar
necessity for dental care.
“If the patient is uncooperative, ance
loud, and aggressive, then there may be like
a re-assessment of the need for dental you
treatment, as well as a discussion with rain
Also available: the family,” Dr. Petty said in conclusion.
—Louise Gagnon, take
Correspondent corp
incom
 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:37 PM Page 13

Fee-based financial advisors called most prudent choice over the long-term
continued from page 1— Another benefit to incorporation is planning and asset protection, and estate transferring assets from the operating
ual pension plan, but says they should not preserving a capital gains exemption transition and risk management. company to the holding company.
that when a dentist sells his or her practice. Depending on the dentist’s situa- Another strategy is to ensure the
incorporate for the sole purpose of estab-
maco- Meeting with a financial planner tion, a financial planner may suggest individual pension plan is held by the
lishing an individual pension plan.
andi- should cover four areas including retire- establishing a holding company and an holding company as opposed to the
“They can use corporate dollars
“If [rather than personal dollars] to fund ment planning, investment planning, tax operating company and may suggest operating company.
tors, their retirement planning,” explains
cated Syed. “It makes sense for dentists who
ion,” are aged 60 and older to have such a
plan. It allows you to put additional
such money aside over and above an RRSP.”
ained Risk management translates to
bout ensuring dentists have adequate disabili-
Dr. ty, critical illness, and life insurance cov- EMS-SWISSQUALITY.COM
cally erage, according to Syed.

1+1=3
d in “They should try and set up disabil-
ity insurance before they incorporate,”
ions explains Syed, noting the disability insur-
dis- ance will cover them for a larger amount
with of money than if they obtain disability
nsure insurance after they have incorporated.
wing Incorporating also permits dentists
Dr. to enjoy the benefits of income splitting

ed to
with their spouses, notes Syed. It is
preferable from a taxable standpoint to
gned
truct
formally lend money to a spouse, if the
spouse is in a lower tax bracket, for the
care
hese
purposes of investment than to just
informally give them money to invest.
relief
PROFESSIONAL ADVICE RECOMMENDED
that “If you formally set up a loan to your
spouse, rather than just informally gave
re in
them money, the growth on that [invest-
Petty
ment] is not taxable back to the dentist,”
crip- says Syed. “If you just gave your money to
how the spouse, and it was invested, any growth
ed to from that investment would be taxable
vers, according to the income attribution rules.”
Syed advises dentists against invest-
ff at
ing on their own given it is human nature
hysi-
to not be completely rational with one’s
r the
own money and because their profession-
al life takes up many hours of their day.
s to
“There are cognitive mistakes that
g in
investors make when they are investing
m a
on their own,” says Syed. “It is very dif-
r to
ficult to invest on your own because
nd to emotions come into play. An advisor can
rans-
be impartial about the decisions.”
with A good financial advisor suggests
m the investments that are at a lower cost and
then are not overly aggressive, but does not
the guarantee specific results, says Syed.
“We can’t guarantee the perform-
ative, ance of the market,” explains Syed. “It’s
ay be
like asking a travel agent to guarantee
ental you get good weather and that it won’t
with rain when you take a vacation.”
sion. There are steps that dentists can
non, take such as setting up a dental hygienist
dent corporation in order to have some
income splitting of the practice.
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Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:37 PM Page 15

GreenDentistry
How water management can help the environment, and save you money
n Dry vacuum systems offer alternative to wet vacuum units that demand copious amounts of water to operate properly
standard vacuum systems, but they

I T TAKES A LOT OF WATER TO OPERATE

the typical dental practice in North
America, and many dental practition-
ers are recognizing that it can make envi-
ronmental and financial sense to mini-
reduce a dental practitioner’s environ-
mental footprint as well as reducing
costly water bills. Dentists will also see a
drop in their electricity charges since dry
vacuum systems use about 50 per cent
mize that water use.
less electricity than the systems that
A typical vacuum system in a dental
require water.
practice is very inefficient in terms of
One of the ways that Dr. Brian
water use, according to Ina Pockrass, an
Wong, an Edmonton dentist, also con-
attorney and co-founder of the Eco-
serves water by using digital imaging
Dentistry Association based in Berkeley,
rather than processing film for his clini-
Calif.
cal images. Dr. Wong says he, his part-
“When you analyse water use at a
ner, and staff try to be environmentally-
dental office, the first thing you need to
friendly in their practices as a general
look at is the vacuum system that is
rule.
used since every office needs a vacuum
“If you need to process film, you
system,” explains Pockrass, whose asso-
have to use water
ciation provides dental practitioners
to rinse off films
with information to make environmen-
in order to read
tally-friendly decisions about their prac-
the films,” ex-
tice and keeps dental students informed
plains Dr. Wong.
about steps they can take to help make
“If you are run-
their practices green when they gradu-
ning digital X-rays,
ate. Po c k r a s s
you do not have to
It’s estimated that the vacuum sys-
in one dental office. In the U.S., where offices, about nine billion gallons of be constantly run-
tem will use 360 gallons of water per day
there are an estimated 122,000 dental water are used. ning water around
“That is water that is clean, potable the developer, and
water that could otherwise be used for that reduces your
In this exclusive series of Special Reports, DENTAL CHRONICLE sets out drinking and bathing that is going down water usage.”
to examine the primary challenges facing dentists in Canada today. This the drain of dental offices every year,” Kathleen
third instalment in the 2010 series The Year of Green Dentistry looks says Pockrass. Bernardi, a regis-
at office water conservation and amalgam separation, and relates the To conserve water, dental practi- tered dental hy-
experiences of some practitioners and industry members as they adapt Dr. Wong
tioners can use water recirculators, gienist with more
and implement some of these new technologies. Publication of this devices that attach to the vacuum sys- than 25 years of
series is made possible by Henry Schein Canada. tems, to halve the amount of water used experience and
“From Henry Schein’s perspective, we really believe it is our responsi- in a vacuum system. her own practice
bility as an active member of the dental industry to look for the trends that known as Wood-
are coming to dentistry,” says Peter Jugoon, Vice DEVELOPMENT OF DRY VAC SYSTEMS land Dental Hy-
President, Marketing and Planning, Henry Schein REDUCES OFFICE WATER CONSUMPTION giene in King City,
Canada. “We are doing a number of things around Better still, dry vacuum systems repre- Ont., notes she
being more environmentally friendly, whether it is sent an alternative to the standard vacu- makes very delib- Ber nar di
internal or external. For example, our distribution cen- um systems that demand copious erate attempts to be eco-friendly in her
ters have gone paperless, so people are walking amounts of water to run, explains practice.
around with headsets on, being directed by central Pockrass.
command to the bins and the products they need to “They do not use water at all,” says USE OF HAND SANITIZERS WILL HELP
Ju g o o n
pick.” Jugoon noted that Henry Schein has also Pockrass, noting dry vacuum systems REDUCE WATER CONSUMPTION
reduced paper consumption in their shipment packing, would be of particular benefit in geo- “Being green is a big part of what I am
replacing paper with biodegradeable air bubble pillows. They are also graphically dry regions. “There are areas doing,” says Bernardi, whose office will
now using brown shipping boxes instead of the white boxes that had to in North America where water is at a earn a stamp of being certified, as
be manufactured through a bleaching process. premium. In those areas, there would be defined by the GreenDOC Dental
“We are doing more and more to ensure that green products are front a great interest in moving to either use of Office Certification Program, which has
and center,” said Jugoon. “The issue around the environment is not isolated a water recirculator or a dry vacuum sys- been developed by the Eco-Dentistry
to dentistry; it’s a global issue that will only continue to grow as time goes by. tem.” Association. Her office would be the
“As the awareness of [green dentistry] increases, as manufacturers The upfront cost of the dry vacu- first in Canada to earn such a certifica-
come out with new green products that can be implemented into prac- um systems is greater than that of the tion.
tices, and as patients demand it, that puts the impetus on us to provide as “One of the biggest differences in
many green solutions as possible.” my office from a typical office is the
This Special Report on Green Dentistry
IN THE NEXTGREEN REPORT: The Fully Paperless Office: Is it possible? was written by Louise Gagnon, a frequent
contributor to DENTAL CHRONICLE. —please turn to page 16

DentalChronicle September 30, 2010 n 15

Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:37 PM Page 16

GreenDentistry
How water management can help the environment, and save you money
continued from page 15— vacuum system is that at 60-plus deci-
vacuum equipment,” Bernardi told bels, it represents less noise pollution
DENTAL CHRONICLE. “It is more expen- than a traditional vacuum system. And
sive to run than a traditional system, but too, Bernardi’s office is free of a cuspi-
I think it is worth it.” dor which contributes to water conser-
An added bonus of the water-free vation.
In addition, Bernardi routinely
Are You Helping to Protect
the World’s Largest Ecosystem?
wate
tal o
the d
utilises hand sanitizers, rather than soap that there is no visible bioburden on way.”
and water, as a means of infection con- one’s hands.
trol. According to Bernardi, the U.S. “I have the hand sanitizers available offic
Centres for Disease Control states that by the sinks in my office,” says Bernardi. mean
the use of hand sanitizers, such as alco- Steam sterilization of almost all her bleac
hol-based hand rubs, is the preferred instruments is another measure that prefe
method of infection control, provided Bernardi has adopted as a means of that
reducing water consumption. She uses expla
stainless steel cups, rather than dispos-
able cups, and employs steam steriliza- OPTI
tion of those cups.
Dr. Imran Baksh, a dentist who has
Usin
cally
been in practice for more than 25 years
and operates Village Green Dental Care
prac
insta
in Kanata, Ont., notes he uses digital tions
imaging to reduce water consumption to of th
develop the radiographs and also to min- the e
imize possible harmful chemicals being
washed down the drain. conc
“You then do not have all the by- of d

Acadia Amalgam Separator. TM products from using chemicals,” to

explains Dr. Baksh. hum
com
THINK OF WASHROOMS ALSO cury
When Dr. Baksh’s office was built, low- amal

The Easy Way to flow toilets were installed. Conventional

toilets use about 23 liters of water per
flush, so having modern low-flow toilets
can make a noticeable decrease in water
dean
Univ
note
consumption in a busy dental office. amal

Manage an It can also be encouraging for staff

and patients to take steps to conserve
water if signs are posted throughout a
dental practice recommending conserva-
being
base
centr

tion. For his part, Dr. Baksh also encour- tion

Eco-Friendly Practice. ages his staff to turn the water off when
it is not in use.
The next major step in Dr. Baksh’s
effort to conserve water is to install
offic
are r
use
Iacop
water-free or dry vacuum equipment.
Such equipment is available to suit a sin- he s
gle practitioner, a large clinic, or a dental remo
Air Techniques is the industry leader for lates
school.
nearly five decades in powering dental One source of potential contamina- “No
practices with first-rate air and evacuation tion to the environment is inappropriate tor w
systems. At Air Techniques, we understand disposal of mercury from dental offices. they
how to create an amalgam separator that works Indeed, dental offices in the U.S. have have
in-line with your evacuation system. Acadia is been cited as the largest source of mer- sepa
ISO 11143 certified and exceeds standards, ensuring cury pollution to the country’s waste- publ
sion
compliance with all US and Canadian regulations. water treatment plants. To minimize that
contamination, dental offices can use
To order or for more information amalgam separators to properly collect cian
contact your local Henry Schein and dispose of mercury-containing den- Cana
Canada Dealer representative. tal waste. says
At this point in time, it is optional, the e
rather than mandatory, for dentists to
use such separators, explains Pockrass. the e
says
“This is critical,” she says. “Some
is rig
municipalities require use of an amalgam
for t
separator, and others do not. It’s a rela-
tively inexpensive piece of equipment,
tions
and this machine will capture the mercu-
mun
www.airtechniques.com ry-containing waste before it enters the
the u
 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:37 PM Page 17

water supply. Our view is that every den- practices is mandatory. “Many dentists completed their Canada by 2005, a goal that was not
tal office has an obligation to deal with But even before their use was installations well before any regulations achieved. However, it is encouraging that
the disposal of mercury in a responsible mandatory, Dr. Dolman notes that many were in place,” says Dr. Dolman. “Some the proportion of Canadian dentists
n on way.” Canadian dentists had amalgam separa- did not go ahead with the installation who use amalgam separators rose signif-
Cleaning water lines in a dental tors installed in their offices, while oth- because they wanted to ensure the instal- icantly over a short span of time: 27 per
lable office in an ecologically responsible way ers waited until lation of the separators was compatible cent of Canadian dentists used these
nardi. means steering clear of using chlorine regulations were with ISO separators in 2003, according to that
l her bleach, according to Pockrass. “It is in place to ensure (International year’s National Survey of Dentists, while
that preferable to use an enyzmatic cleaner their configura- Organization for 70 per cent used the separators in 2007.
s of that uses biodegradable enzymes,” she tions were consis- Standardization) In addition, manufacturers have
uses explains. tent with regula- standards.” developed amalgam separators that are
pos- tions. What was more efficient: where previous separa-
iliza- OPTIONS FOR AMALGAM SEPARATORS Cities such as first a good deed, tors captured chunks of mercury, newer
Using amalgam separators is an ecologi- Montreal and Dr. Iacopino Dr. Pockr ass and then a regula- models can capture fine particles,
o has cally responsible way for dentists to Toronto have tion, has now observes Dr. Fred Pockrass, a co-
years practice, and many dentists have adopted by-laws evolved into a founder of the U.S.-based Eco-Dentistry
Care installed the separators, ahead of regula- requiring dental standard of prac- Association, an organization promoting
igital tions requiring them to do so, because facilities to install tice, according to environmentally-friendly dentistry.
on to of their own concerns about hazards to ISO 11143 certi- Dr. Dolman.
min- the environment. fied amalgam sep- But even INCREASED NEED FOR SEPARATORS
being Mercury is the heavy metal that is of arators. Moreover, though there is Dr. Pockrass, a Canadian dentist now
concern, representing up to 50 per cent Environment growing con- based in Berkeley, Calif., recognizes that
e by- of dental amalgam, and its toxic effects Canada has Dr. Dolman Dr. Hiltz sciousness about there is a decreasing use of amalgam as
als,” to the environment, animals, and worked in con- the environment a restorative material because of envi-
humans have been documented. The junction with the CDA on the issue of and the fact that Environment Canada ronmental concerns expressed by
components consist of elemental mer- amalgam waste disposal for many years. has issued directives aimed at the appro- patients and by dentists themselves.
cury vapour, dental amalgam scrap, A Memorandum of Understanding on priate disposal of amalgam in Canadian Clearly, dentists are turning to alterna-
low- amalgam waste, and amalgam sludge. Canada Wide Standards (CWS) on dental offices, targets for appropriate tives to amalgam such as resins, porce-
ional Anthony Iacopino, DMD, PhD, Mercury for Dental Amalgam Waste was disposal have not yet been met. lains, and ceramics. Dr. Pockrass stresses
r per dean of the faculty of dentistry at the signed in 2002, which outlined a series of The 2007 Survey of Dentists con- that does not mean that there is a declin-
oilets University of Manitoba in Winnipeg, best practices. cluded that 70 per cent of Canadian den- ing need for amalgam separators.
water notes that there are many options for In addition, Environment Canada tists use an ISO certified amalgam sepa- “There will actually be an increased
. amalgam separation units, with some issued a Pollution Prevention Notice rator, and that roughly the same percent- need for amalgam separators,” explains
staff being based on sedimentation, some obligating dentists to consider the imple- age of Canadian dentists who place and Dr. Pockrass. “Many of the baby
serve based on filtration, and some based on mentation of these best practices, remove restorations had used a licensed boomers want beautiful white teeth. In
out a centrifugation. including the installation and mainte- waste carrier to remove amalgam waste. the transformation to having beautiful
erva- “I think by this time, most regula- nance of an ISO 11143 certified amal- The goal of the CWS was a 95 per cent
gam separator. decrease in mercury release across —please turn to page 23
cour- tion bodies that govern how dental
when offices operate and regulate licensure,
are requiring dental offices and clinics to
ksh’s use [amalgam] separators,” says Dr.
nstall Iacopino.
ment. “They function in different ways,”
a sin- he says, estimating amalgam separators
ental remove 98 or 99 per cent of the particu-
lates that come out of dental offices.
mina- “No matter how the [amalgam] separa-
riate tor works, they generally all work, and
fices. they all work well. As a profession, we
have have been quick in terms of having the
mer- separators in place and using them. The
aste- public can be confident that the profes-
that sion is doing the right thing.”
use Dr. Barry Dolman, a Montreal clini-
ollect cian and former president of the
den- Canadian Dental Association (CDA),
says dentists acknowledge that caring for
onal, the environment is significant.
ts to “We understand that protection of
ass. the environment is an important issue,”
says Dr. Dolman. “We want to do what
ome
is right for the patient and what is right
lgam
for the environment.”
rela-
In a growing number of jurisdic-
ment,
tions in the U.S. and Canada, whether
ercu-
municipality, county, province, or state,
s the
the use of amalgam separators in dental
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 18

DE

De
com
aro
mo
65
lan
org
we

ou
Am
Pa
De
me

den
for
cou
tio
tor

Int
pre
int

Th
ev
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 19

DENTAL TRIBUNE | SEPTEMBER 30, 2010 Clinical Practice 19

Implant fracture: A look at the

physical mechanisms for failure
Dental Tribune International Publishing Group is Considering the need for the removal of fractured implants must be balanced against the risk of increas-
composed of the leading dental trade publishers ing damage, report authors Drs. Dov Almog, Odalys Hector, Samuel Melcer, and Kenneth Cheng.
around the world. Its combined portfolio includes
more than 100 trade publications that reach over
650,000 dentists in more than 90 countries and 25
languages. The group’s activities also include the
organization of continuing education programs as
T he etiology and physical
mechanism
dental implants phenome-
of fractured
However, as oral implantology
has been the fastest growing seg-
ment in dentistry, the gaining of
Chaska, Minn.) were placed and
restored in 2003. The implants were
placed as per protocol, utilizing a
well as dental congresses and exhibitions. non have been reviewed and studied insight into these failure processes, surgical template consisting of two
The World Dental Federation (FDI) and numer- at length in recent years.1-8 For the including the accurate understand- guiding sleeves (DePlaque, Victor,
ous regional dental associations, such as the Latin most part, the studies concluded ing of critical anatomical, restora- N.Y.).
American Dental Federation (FOLA) and the Asia that the crown-to-root ratio guide- tive and mechanical information, The implants were allowed to
Pacific Dental Federation (APDF), have chosen lines associated with natural teeth might stimulate the clinicians' integrate for six months. No surgical
Dental Tribune International Group as their official should not be applied to a crown-to- implementation of preventive action complications were noted during
media partner. implant restorations ratio. that may avoid the future fractures this time. At the conclusion of the
Dental Tribune is the first global newspaper for According to these studies, the outcome with dental implants. six-month waiting period, the
dental professionals in a concise and highly readable crown-to-implant ratios of those implants were uncovered in the nor-
Case report
format that is published in the native language of the implants that were considered suc- mal manner and healing abutments
A 72-year-old Caucasian male
country in which it appears. An experienced interna- cessful at the time the reviews took placed.
recently presented to our clinic.
tional correspondent network and renowned local edi- place were similar to those implants The implants were subsequent-
Consistent with the patient's chief
torial boards ensure the highest journalism standards. that failed. ly restored with implant-supported
complaint, a comprehensive oral
As the Canadian affiliate of the Dental Tribune Apparently, according to some crowns that were functional for
and maxillofacial examination,
International network, Dental Chronicle is pleased to of these studies, the guidelines that approximately six years until the
including full-mouth X-rays,
present this special section containing articles of are used by some clinicians to estab- implants fractured.
revealed, among other things, two
interest from the global editions of Dental Tribune. lish the future prognosis of implant While this treatment option was
fractured endosseous implants #6
supported restorations are usually developed with an appreciation of
and #7 (Fig. 1).
Three essential lessons for empirical and lack scientific valida-
These 3.3 mm x 15 mm
the patient’s occlusal and mechani-
tion as far as the possible causes for
every new dentist ................21 implant fractures.
implants (Lifecore Biomedical, Continued on page 20

Where can you reach 600,000+

dentists in 25 languages monthly?

Official Media
Partner of

roots lab laser ortho perio

issn 1616-6345 Vol. 2 Issue 1/2007 issn 1616-6345 Vol. 1 Issue 1/2007 issn 1616-6345 Vol. 1 Issue 1/2007

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dentistry _ beauty & science the international magazine of endodontics the international magazine of dontal technology international magazine of laser dentistry the international magazine of orthodontics the international magazine of periodontics
implants
international magazine of oral implantology
1 2007
1 2007
1 2007
1 2007
1 2007
1 2007
1 2007

_case report
Utilization of Zirconium Oxide in Fixed
Restorations on Implants and Natural
Teeth

_implant market
_Feature Article _clinical _clinical Implantology still runs the business
_Feature Article The New Era of Foramenal Treating class III dento-skeletal in 2007
_specialty The New Era of Foramenal Supportive oral care in
Location malocclusions with the cancer patientts
Treatment of a class-II deformity with _clinical Location “Muscle Wins” philosophy
skeletal open bite and latero-occlusion Treatment of a tooth with a lateral radioluceny:
_DGZI events
_Special _science 3rd Arab-German Implantology Meeting
a diagnostic dilemma _Special _innovation
_expert article Control and Elimination of Medications: impact on oral health of DGZI—Dubai, April 5–6, 2007
Control and elimination of Endodontic Infection Virtual indirect bonding in 3-D:

Essential Dental Media

Smile for more self-confidence? _case report endodontic infection does it have a future in orthodontics?
Silver point retreatment: a case report _meetings
_tandem feature _Case Report _Case Report _science
The use of smile libraries for cosmetic “Selling a product, not a procedure...”
_interview ICase vPresentations from Case Presentations from The impact of genes on facial morphology
dentistry Implants in endodontics Endodontic Practice
Endodontic Practice
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 20

20 Clinical Practice DENTAL TRIBUNE | SEPTEMBER 30, 2010 DE

To remove or not remove fractured implant? T

Continued from page 19 primary closure of the soft tissue Co
cal circumstances and habits, following over the remaining implant bodies
the implants’ fracture, a retrospective
analysis of the site planned for the
implants revealed extended inter-
occlusal space on the articulated models
#6 and #7, i.e., “put them to sleep”
(Fig. 4). This was followed by inser-
tion of an immediate acrylic remov-
able partial denture, and subse-
A
and
and widespread occlusal wear of the quently, a cast partial denture will be
ente
opposing dentition (Fig. 2). fabricated.
Just
When the patient presented recent- This report attempts to provide
ly to our clinic, the only portion of the an argument in favor of the consid-
be th
restoration that was still present in his eration of physical mechanisms as
mouth was abutment #6, which was still potential contributors to implant
to re
connected to one of the fractured fractures.
scho
implants, and was removed with a hex While controversy continues to
had
driver (Fig. 3).
Continued on page 21
Proceeding with careful assessment
key
of all the available retrospective diag-
touc
nostic information and upon further dis-
ricul
cussion with the patient, several diag-
nostic assumptions and one follow-up
treatment option were established that
included replacement of the implant- I’m n
supported crowns by a removable cast Figs. 1A, B: Implants #6 and #7 (Lifecore Biomedical,3.3 mm x 15 mm) before fracture (A) and after the been
partial denture. fracture (B). ing a
Considering the need for the the o
removal of fractured implants must be thos
balanced against the risk of increasing mak
damage, a decision was made to remove pay y
the remaining abutment and the frac- track
tured piece of implant #6 allowing for
team
ly de
cess
sion
mate
annu
age
over
Figs. 2A, B: Retrospective analysis of the site planned for the implants #6 and #7 (A) revealed an
extended overbite, requiring long crowns (B) to meet esthetic needs, and at the same time, the
opposing occlusion presented extensive occlusal wear. C
exi
can
dic
sam
im
clin
sio
an
lem
ere

one
imp
tita
cal

ere
eni
Figs. 4A,B,C: The remaining abutment and the fracture piece of implant #6 were
removed, alllowing for primary closure of the soft tissue over the remaining implant the
Figs. 3A, B: By default, based on phyisical principles, once an implant has intergrated in the mu
bodies #6 and #7 (A, B), followed by an insertion of an immediate acrylic removable
bone, the weakest point is the fulcrum where the internal screw engages the implant (A). Note
partial denture (C)
the fracture level in implant #7 and fracture line in implant #6 (B).
 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 21
010 DENTAL TRIBUNE | SEPTEMBER 30, 2010
Three essential lessons for every new dentist
Consultant discusses key principle considerations necessary for running a successful dental practice
A fter years of schooling, thou-
sands of dollars in tuition, hours
upon hours of clinics and exams,
and tests and on and on, finally you
entered the working world as a dentist.
Just you and the patients.
Wouldn’t it be great if it could really
be that simple?
It’s likely that it didn’t take you long
to realize that once your tour in dental
school was over, the learning process
had only just begun.
Moreover, there are at least three
key lessons that were probably barely
touched upon in the dental school cur-
riculum.
Lesson No. 1:
How to deal with people
I’m not talking about the patients. You’ve
the been trained to manage them. I’m talk-
ing about the people you see every day,
the ones you work with elbow to elbow,
those you depend on to represent you, to
make sure you have enough money to
pay your bills, to keep your schedule on
track, etc.
Obviously, I’m talking about your
team. Your success as a dentist is direct-
ly dependent upon your employees’ suc-
cess. Unfortunately, one bad hiring deci-
sion can cost you a small fortune—esti-
mates range between 1.5 to 5 times
annual compensation—it can also dam-
age patient relations, staff morale, and
overall effectiveness of the practice.
an
e
Controversy still remains over crown-to-root ratio
Continued from page 20
exist as to whether crown-to-root ratio
can serve as an independent aid in pre-
dicting the prognosis of teeth,9 the
same certainly applies to crown-to-
implant ratio, unless multiple other
clinical indices such as opposing occlu-
sion, presence of parafunctional habits,
and material electrochemical prob-
lems, just to name a few, are consid-
ered.
Implant fractures are considered
one potential problem with dental
implants, especially delayed fracture of
titanium dental implants due to chemi-
cal corrosion and metal fatigue.2
Following careful review of the ref-
erenced articles, which are very enlight-
ening, we realized that to a great extent
they support our theory that there are
multiple factors involved in implant
Clinical Practice 21
Given what’s at stake, pay close
attention to Lesson No. 1: Do your best to
hire the best and never hire under pres-
sure. Follow these steps and take a clear
and measured approach to ensure that
every employee you hire is the best fit for
your growing practice.
Assess the systems before you bring
in a new employee. If you’re hiring an
office manager, look at business opera-
tions first. Are the business systems,
scheduling, collections, recall, etc.,
working efficiently? If not, this is your
chance to fix them, to integrate new pro-
tocols and establish up front how you
want these handled in your practice.
Take 15 minutes. Set aside 15 min- the position. “maybe.” The “yes” candidates are the
utes to think about what you want the Keep the copy simple but answer first to be considered.
person in this position to do. Make a list. the reader’s questions—job title, job Pre-screen applicants on the
Consider what you are looking for in this scope, duties, responsibilities, benefits, phone. Address your most pressing
individual. application procedures, financial incen- concerns up front. If there are gaps in
Write a job description. Once you’ve tives, and location. Direct prospects to employment history, now is the time to
given some thought to the position, your website to learn more about your find out why. Ask the applicant what
update or write a job description for the practice and the position. salary range she/he is expecting.
job tailored to attract the employee you Read the resumes; don’t just scan Listen for tone, attitude, and grammar
need. Include the job title, job summary, them. Highlight those qualities that on the phone, particularly if the posi-
and specific duties. This clarifies what match the position’s requirements. Look tion requires handling patient calls.
skills the applicant must possess and for longevity in employment. Be careful Based on the applicant’s phone
explains what duties she/ he would per- of those applicants that only note years, demeanor, would this person represent
form. such as 2008 to 2009. Chances are this your practice well?
Cast a wide net. Develop an ad and person was hired in December of ‘08 and Prepare for the interviews. Conduct
place it on multiple websites and in dif- fired in January of 2009. interviews using a written set of stan-
ferent publications. Promote those Watch for sloppy cover letters. The dard questions for each applicant so you
aspects of the job that will have the applicant may have poor attention to are able to compare responses to the
greatest appeal, including money. Sell detail. Flag resumes with “yes,” “no,” or Continued on page 22
fractures. Therefore, it is imperative that the dictors to implant fractures.
These factors include magnitude, clinician be knowledgeable about the Therefore, it is essential for us to
location, frequency, direction and dura- diversity of factors before recommend- familiarize ourselves with the under-
tion of compressive, tensile and shear ing dental implants. Errors in diagnos- standing, and diagnostic competence of
stresses; gender; implant location in the ing potential contributors to implant the multiple factors involved in implant
jaw; type of bone surrounding the fractures are the most common reason fractures. Once observed, this predictor
implant; pivot/fulcrum point in relation that dental implants fail. would certainly lead to better diagnosis
to abutment connection; implant design; and treatment planning.
Conclusion
internal structure of the implant; length
Although, according to the literature,
of time in the oral environment as it
the use of the crown-to-implant ratio in
relates to metallurgic changes induced
addition to other clinical indices does About the authors
in titanium over time; gingival health
not offer the best clinical predictors, and
and crown-to-implant ratio.
even though no definitive recommenda- - Dov M. Almong, DMD, prosthodontist,
Considering the multiple factors
tions could be ascertained, considering chief of the dental service, VA New Jersey
involved in implant fractures, both phys-
that dental implants are becoming Health Care System. (VANJHCS)
ical and biological, we can only assume
increasingly popular, an increase in the - Odalys Hector, DMD, general dentist,
that it can happen especially if the forces
number of failures, especially due to late VANJHCS
of the opposing occlusion and/or para-
fractures, is to be expected.8 - Samuel Melcer, DMD, periodtist, assis-
functional habits are greater than the
This report attempted to provide an tant chief of the dental services, VANJHCS
strength of the implant, especially over
argument in favor of consideration of - Kenneth Cheung, DDS, oral and max-
time.
physical mechanisms as potential pre- illofacial surgeon, VANJHCS
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 22

22 Clinical Practice DENTAL TRIBUNE | SEPTEMBER 30, 2010

Considerations for leading your team to success De

Continued from page 21
same questions.
Avoid asking any personal questions.
Ask follow-up questions based on the
applicant’s responses. Jot down personal
details to keep track of who’s who. The
candidate is likely to be on her/his best
behavior in the interview. If the applicant
doesn’t impress you now, it will not get
better after she/he is hired.
Test for the best. Take advantage of
Internet testing tools that are available to
dentists. Such testing has been used in the
business sector for years to help compa-
nies identify the better candidates for spe-
cific positions.
Check ‘em out. Once the interview
and testing process has enabled you to
narrow the selection down to a couple of
candidates, check their references and
work histories. This step can yield
tremendously helpful information and will
save you from multiple hiring horrors.
Budget for training. Give your new
employee the tools and the knowledge to
achieve her/his best, and you’ll both ben-
efit significantly. Above all else, when it
comes to staff hiring, make your decisions
based on real data, not a candidate’s sunny
disposition or your “gut feelings.”
Lesson No. 2:
Lead your team to excellence
If you’re frustrated by what you perceive
as average or below average team per-
formance, determine if you’ve given them
the foundation to achieve the standards
you expect.
First, avoid the most common pitfall
in leading employees: Assuming that your
staff knows what you want. Don’t assume.
Spell out your expectations and the
employees’ responsibilities in black and
white, and do so for every member of your
team from the beginning. Do not convince
yourself that because they’ve worked in
this dental practice for X number of years,
they know how you want things done.
They don’t, and they will simply keep
performing their responsibilities accord-
ing to what they think you want unless
they are directed otherwise.
Recognize the strengths and weak-
nesses among your team members. All
employees bring both to their positions.
The fact is that some people are much bet-
ter suited for certain responsibilities and
not others. Just because “Rebecca” has
been handling insurance and collections
for the practice doesn’t mean she’s effec-
tive in those areas. Look at results.
Rebecca may be much more success-
make the most of team strengths. In addi-
contin
tion, be open to maximizing those
strengths through professional training. findi
Give ongoing direction, guidance and resea
feedback to your team so that they know
fecti
where they stand. Don’t be stingy. Give
much
able
praise often and appraise performance
resul
regularly. Verbal feedback can be given at
any time, but it is most effective at the very
able
moment the employee is engaging in the
ety o
behavior that you either want to praise or
as a
correct.
meth
Nip problems in the bud and you’ll
said
avoid numerous thorns in your side. If an
to la
employee is not fulfilling her/his responsi-
factu
bilities, address the issue privately and
directly with her/him. Be prepared to dis-
GEN
cuss the key points of the problem as you
A so
see it as well as possible resolutions.
Use performance reviews to motivate
and encourage your team to thrive in their
positions. Base your performance meas-
Ne
urements on individual jobs. Focus on contin
er than that, they are hammering your appointments, she should record the time
specific job-related goals and how those
profits. Here’s what may be happening: needed for all three appointments.
relate to improving the total practice.
Record the total fee for the proce-
Used effectively, employee performance o You have too many employees. dent
dure. Determine the procedure value per
measurements and reviews offer critical o You are giving raises based on longevity boom
hourly goal. To do this, take the cost of the
information that is essential in your efforts rather than productivity/perfor- put i
procedure (for example, $900) divide it by
to make major decisions regarding mance.
the total time to perform the procedure still h
patients, financial concerns, management o The hygiene department is not meeting
($900÷120 minutes). That will give you have
systems, productivity, and staff in your the industry standard for production,
your production per minute value amal
new practice. which is 33 per cent of total practice
(=$7.50). Multiply that by 60 minutes
production.
Lesson No. 3: ($7.50 x 70=$450). effor
o The recall system, if there is one, is not
Keep your hands in the business Compare that amount to the dentist’s
structured to ensure that the hygiene
It doesn’t take long to recognize there are hourly production goal. It must equal or a hu
schedule is full and appointments are
many hats for dentists to wear. The hat exceed the identified goal. Dr. P
kept.
that says “The CEO” is just as important as Now you can identify tasks that can men
the hat that says “The Dentist.” It’s critical Maximizing productivity. Hand-in- be delegated and opportunities for train-
that you completely understand the busi- hand with practice overhead is produc- ing that will maximize the assistant’s func- dispo
ness side of your practice. tion, and one area that directly affects your tions. You also should be able to see more Dr. P
There are 22 practice systems and production is your schedule. Oftentimes, clearly how set up and tasks can be made
you should be well-versed in each of new dentists simply want to be busy, but Ame
more efficient.
them. If not, seek out training for new it’s more important to be productive. Asso
A career in dentistry is one of the
dentists. The effectiveness of the practice Follow these steps to maximize productiv- most personally and professionally fulfill-
ity. gam]
systems will directly, and profoundly, ing fields you can choose. With the right
affect your own success today and First, establish a goal. Let’s say yours team, clear leadership, and effective busi-
CONF
throughout your entire career. is to break $700,000 in clinical production. ness systems, you can enjoy tremen-
The
For starters, routinely monitor prac- This calculates to $14,583 per week, not dous personal success and lifelong
their
tice overhead. It should break down including four weeks for vacation. financial security for you and your Marg
according to the following benchmarks to Working 40 hours per week means you'll family. issue
ensure that it is within the industry stan- need to produce about $364 per hour. If
Asso
dard of 55 per cent of collections: you want to work fewer hours, obviously
per-hour production will need to be high- About the author who
o Dental supplies: 5 per cent
er.
o Office supplies: 2 per cent finds
A crown charged out at $900, which Sally McKenzie is CEO of McKenzie
o Rent: 5 per cent “The
takes two appointments for a total of two Management, which provides success-
o Laboratory: 10 per cent proven management solutions to dental
hours, exceeds the per hour production been
o Payroll: 20 per cent practitioners nationwide. She is also editor
goal by $86. This excess can be applied to amo
o Payroll taxes and benefits: 3 per cent of The Dentist’s Network Newsletter at
any shortfall caused by smaller ticket pro-
o Miscellaneous: 10 per cent www.thedentistsnetwork.net; the e-
cedures. Use the steps below to determine 1114
Keep a particularly close eye on staff the rate of hourly production in your prac- Management Newsletter from

ful at scheduling and recall and would be
a much more valuable employee if she
were assigned those duties. Don’t be
afraid to restructure responsibilities to
salaries. Payroll should be between 20 and
22 per cent of gross income. Tack on an
additional 3 to 5 per cent for payroll taxes
and benefits. If your payroll costs are high-
www.mckenziemgmt.com; and The New tion
tice.
Dentist magazine, www.thenewdentist.net. erate
The assistant logs the amount of time
She can be reached at (877) 777-6151 or
it takes to perform specific procedures. If
sallymck@mckenziemgmt.com.
the procedure takes the dentist three De
 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 23

010

Dental Laser Buyer’s Guide: Significant advances in laser technology

continued from page 5— 980 features a user definable pulse mode, The SIROlaser Advance has a color
SIROlaser Advance
findings were supported by her own a touch button monochromatic screen touch screen that allows for 24 applica-
research into the efficacy of this disin- display, a 300 µm laser fiber, a KaVo tions to be programmed. The model also
fection system. Dr. Benhamou said, laser fiber handpiece, and foot control. It has the potential to add up to five pass-
much like Dr. Galler, she too was often weighs 3.5 kg. Optional components word protected profiles, so that different
able to avoid surgery for patients as a include a laser whitening handpiece and dentists within a shared practice can set
result of this system. fiber, or an alternate 200 µm fiber. The the device to their own preferences. It’s
The Periowave HHL-1000 is avail- premium package includes three protec- extremely light at under half a kilogram.
able for $3,450 and is offered with a vari- tive laser goggles, a diode array, a peri- screen and multiple touch buttons. At This laser also stores parameter data
ety of payment plans for the laser as well staltic pump, a second handpiece with almost 20 kg, it’s a larger model, but the anonymously from each treatment ses-
as associated treatment packages of water cooling, new software, and a color wheels underneath the cart permit it to sion, which can be transferred to a PDC
methylene blue formulation. Dr. Loebel touch screen display. be moved from chair to chair. It’s effec- using a USB drive. It can be operated
said the treatment packages are designed tive for restorative procedures and early using a light touch finger switch or an
to last two years from the date of manu- BiolaseTechnology Inc periodontal treatment. optional foot control. A rechargeable bat-
facture. The Waterlase C100 is an all tissue Er, tery pack allows the laser to be deployed
Cr3+: YSGG, 2780 nm laser. It allows Sirona (SIROlaser Advance) more flexibly within the practice.
GENTLEray 980 Classic by KaVo for multiple pulse repetition rates from
A soft-tissue diode laser, GENTLEray 10, 15, 20, 25, or 30 Hz. It has an LCD CEO of AMD LASERS talks about the Picasso
continued from page 6— They are ready to incorporate a laser
New amalgam separators more efficient which is ultra-affordable, contemporary in
design, and easy to integrate into their practice. We are lucky to have partnered with
continued from page 17— white teeth, all that old, degraded amal- a great distributor, Oral Science, who will exclusively distribute AMD LASERS den-
time
gam will have to be removed. tal laser products throughout Canada.
“We [the Eco-Dentistry Association] are spending a lot of time talking with
roce- What features and capabilities do you perceive Canadian dentists will
dentists who are doing cosmetic dentistry and doing porcelain fillings for baby
e per appreciate most about Picasso and Picasso Lite?
boomers,” says Dr. Pockrass. “We are telling them that whether amalgam is being
of the The Picasso and Picasso Lite are ideal for both the first-time laser user and the
put in or taken out, dentists need to deal with it responsibly.”
it by
While the use of amalgam is declining as a restorative material, dentists should expert laser practitioner. The Picasso offers unprecedented versatility, low operat-
edure still have the choice to use amalgam. Some countries such as Norway and Denmark ing cost, and affordability. From a performance standpoint, both Picassos perform
you have banned the use of dental amalgam, but Dr. Pockrass says the option to use a very wide range of soft-tissue surgical, periodontal, and endodontic procedures.
value amalgam should exist. The Picasso is also indicated for whitening procedures. Picassos are the only dental
nutes lasers that offer both the convenience of disposable tips and low cost strippable
“I would hope that there is not a need for a ban,” says Dr. Pockrass. “I think
fibers. The Picasso Lite is the world’s easiest to use dental laser marketed at an ultra-
efforts for self-regulation [in using amalgam separators] can be effective.”
affordable pricepoint.
ntist’s The cost of purchasing and maintaining an amalgam separator should not be
Dentists worldwide have greatly enhanced and streamlined their practices by
al or a huge deterrent to ensure dentists practice proper disposal of amalgam, observes
incorporating the Picasso brand. Glenn van As, DMD, Medical Director for AMD
Dr. Pockrass. “It is not like buying a new computer system or new X-ray equip-
LASERS, practices in North Vancouver, and incorporated the Picasso brand dental
t can ment,” he notes.
laser into his practice a few years ago with resounding results.
rain- Similarly, being pressed for time should not be an obstacle to the appropriate
func- disposal of mercury waste generated through the removal or use of amalgam, adds
Looking forward, what other great things may we expect from AMD LASERS?
more Dr. Pockrass. “It should not have a big effect on time management.”
I believe AMD LASERS’ future is bright and exciting. We are currently developing
Education is the key to expanded use of amalgam separators across North
made innovative technology and proto-
America, according to Ina Pockrass, a co-founder of the Eco-Dentistry cols to not only refine the Picasso
Association. brand, but to expand it. First on
f the Access Product Information
“There are many high-tech dentists out there who take out that material [amal- the list is the Picasso Perio; it is
ulfill-
gam] but do not think they need a separator in the office,” she says.
your way through Dental Chronicle’s
right expected to debut in late Fall 2010. READER SERVICE
busi- Also currently in the devel-
CONFIRM PROPER WASTE DISPOSAL opment stage is an All Tissue More information is available on all of the
men-
The tendency across Canada is that dentists are installing amalgam separators in Laser (ATL) which will complete advertised or highlighted products in this
long
their offices to minimize mercury particles getting into wastewater, according to Dr. the comprehensive soft- and hard- edition of Dental Chronicle
your Margot Hiltz, an associate dentist based in St. John’s, Nfld., who wrote about the tissue product line. Additional
issue of dental amalgam and the environment in the Journal of the Canadian Dental products recently introduced By FAX Go to page 25, circle the number
Association in 2007. include a bleaching handpiece of the product, provide your
“The trend is that most people are putting them [separators] in,” says Dr. Hiltz, accessory which accompanies the contact info and
who observes that a lot of amalgam is collected when amalgam is being placed, but Picasso, and a variety of clinically fax (toll free) to 1-800-865-1632
finds that even a greater amount is collected when the amalgam is being removed. compatible accessories that
enzie By PHONE Call our toll free Reader
“They [separators] have been of value in the removal of amalgam.” accompany the Picasso Lite. We
cess- Service Hotline at 1-866-632-4766
The amount of amalgam waste and sludge that Canadian dentists produce has also intend to expand our ICLE
ental
been estimated from a low of about 800 kg annually to close to three times that and university programs.
editor By INTERNET Go to our product
amount on an annual basis, according to Dr. Hiltz. Finally, in the very near
er at information web site, indicate the product,
She notes that chair-side traps and vacuum filters are not as effective as ISO future, we will be make expansive
e- 11143-certified amalgam separators in capturing amalgam waste. forays to take the company brand and provide your contact info:
from It’s also important for dental practitioners to research hazardous waste collec- into non-dental markets includ- www.dentalchronicle.info
New tion services to ensure these services are capable of handling the waste that is gen- ing medical and veterinary appli- We'll do the rest
t.net. erated by their dental office, according to Dr. Hiltz. cations.
51 or

DentalChronicle September 30, 2010 n 23

Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 24
DentalVitae
H E CAN’T DRIVE A RACE CAR ANY
more because of a blood clot in his
leg that requires him to take blood
thinners, but Winnipeg dentist Dr. Brian
Friesen said he still remembers when, at
22, he got behind the wheel of his first
drag racer.
“It’s very exciting to hear the
engines start up and then you’re driving
it,” said Dr. Friesen.
Unlike street driving, Dr. Friesen
said, there is no margin for error.
“It can be terrifying. You have to
have a huge amount of control,” said
Dr. Friesen. “These cars have three-
thousand horsepower and you’ve got to
control that power.”
Fail to control that power, due to a
mechanical malfunction or driver error,
and the result is serious injury or death,
said Dr. Friesen, who said he sees one
driver die on the track each year.
“Truly these guys are warriors that
don their safety suits and go in there and
they could die, and that’s what you real-
ize when they do it.”
YOU’RE ON YOUR OWN BEHIND WHEEL
Another difference between traditional
driving and drag racing, Dr. Friesen said,
is that during lessons there is no driver
instructor in the car. When Dr. Friesen
first received his lessons, drivers were
given training exercises that gradually
increased in difficulty.
“[The tasks] progressed as the days
went on, until you eventually made a full
run down the track.”
Dr. Friesen said he started with a
simple burnout. That’s when the rear
wheels of the car sit in a puddle of water
just before the starting line, and the driv-
er applies the front brakes while revving
the engine. The rear wheels spin in the
puddle while the front brakes hold the
car in place, heating up the tire rubber so
the tires get a better grip on the track
surface.
Prospective drivers who did an ade-
quate job, said Dr. Friesen, were permit-
ted to advance to more complicated
driving tasks, but not everyone made it
that far.
“Some of the guys, they weren’t
able to do it correctly, so they were going
to have to try to repeat that until they
could get it right,” said Dr. Friesen.
“Some of the guys were so afraid of it
that they never even got down the track,
they were so afraid of the car. I was able
to make a full run at the end because I
was more comfortable with it, I under-
24 n September 30, 2010
Leisure, travel, and making the most of your own time
Profile
Dentist’s ‘Funny Car’ runs
405 km/h in 1/4 mile
Drag car pumps out 3,000 horsepower
n Though he doesn’t pilot the race car anymore, Dr. Brian
Friesen leads a crew of volunteers up against the big guns
stood it, and I drove it within my
means.”
Dr. Friesen said his interest in cars
and drag racing started early in his child-
hood, and has continued through his
adulthood and training in dentistry.
against cars with multi-million dollar
backing, he said, but they’ve had their
victories, particularly in September of
VA
nol
acr
2009.
“We were runner up in the U.S.
Nationals, which is the biggest race of
the year, and we just lost by a hair,” Dr.
poly
ma
Thr
ing
Friesen said. “That was our biggest are
abl
accomplishment for a bunch of guys low
from Winnipeg.” acc
Their competitor at that race, Rick Pro
Jackson, had significantly greater
resources than Dr. Friesen.
sap
sea
Circ
“Jackson’s car is from California,
[he] had a crew of paid tuners and peo-
ple like that all over and our crew was all Sm
com
volunteers,” he said. “So it was quite
mu
good to compete with him and almost
out
win.”
tion
Not bad for a pit crew that was paid rial
only in plane tickets and meals, said Dr. initi
Friesen. low
act
hig
TRY DIFFERENT THINGS
140
“Some of the people I’ve known for
fou
twenty years, some of the people I’ve rad
known from when we drag raced in the Fro
‘80s, and other people, [30 -ear veteran Circ
drag race driver] Roger Bateman [for
example], I just called him one day and
he’s a good driver and he agreed to drive
Th
our car. He was semi-retired, we’ve had The
four years with him and he’s done a great des
job,” Dr. Friesen said.
“He answered the phone, we chat-
ted, he agreed to drive our car in Las
Vegas at the National Hot Rod
Association’s Winternationals, and we
“I’ve tried different types of car rac-
liked what we saw. He was very capable
ing, I’ve tried ice racing in the winter,
of driving the car and we stuck with him
and I did have a drag race car and go to
after that.”
high performance driving schools,” said
A dentist who drag races might
Dr. Friesen.
seem a little different, but considered
Dr. Friesen operates a dental prac-
along with Dr. Friesen’s other activities,
tice in Winnipeg, and continues his
involvement in the sport of drag racing.
Although he doesn’t drive a race car any-
more, he is now the owner of a Ford
it’s really not that much out of the ordi-
nary.
He’s also been a bodybuilder, a
cross country skier, and a runner.
N
Mustang Top Alcohol Funny Car, a
machine that has a top speed of 405
“I guess I test myself to see how W
competent I can be at these things,” Dr.
km/h (252 mph) with an elapsed time of
Friesen told DENTAL CHRONICLE. A
5.655 seconds in the quarter mile.
“Certainly the bodybuilding thing, I did A
“I have to pay all of the bills which
that for a while to see if I could do it and
are quite staggering when we’re compet- B
get down to a certain percentage of
ing with multi-million dollar teams, so
body fat, and then once I did it I sort of C
we’ve had sponsorships over the years, G
left it alone. Running was part of my fit-
and we’ve had a sponsor stay very suc- G
ness regimen and at one point I ran a
cessfully for a couple years.”
“If you win, you can possibly make
half marathon just to see if I could do H
it,” said Dr. Friesen. O
a lot of money at the end of the year,
“Once I achieve my goal I sort of O
but you have to win every race,” said Dr.
abandon it and move on.”
Friesen.
—Josh Long
P
No easy task when competing
Assistant Editor S
DentalChronicle
 Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 25

e
NewProducts
A selection of the month’s most innovative new products
ollar
VALO’s multi-wavelength LED tech- Flip Top Cassettes have a unique The KODAK 1500 intraoral cam- The S600NL has a standard sized HygienePro Ultrasonic Scaler has
their
nology produces high intensity light double-hinge with easy to operate era’s liquid lens technology and true head to allow easy and comfortable 16 inserts for comfort and efficien-
r of across the 395-480 nm spectrum to latch for easy opening and closing. autofocus works like the human eye access to the posterior of the cy. Ergonomic grip designs in hard
polymerize all light-cured dental The fold under fliptop props up the to ensure effortless mouth. The S700NL has a torque and soft
U.S. materials. cassette image capture and head for styles fea-
ce of Three cur- at a con- clear, detailed images. greater ture tex-
” Dr. ing options venient Combined with the power. tured non-
ggest are avail- angle for industry’s highest still Both slip surfaces. A wide variety of tip
able. The easy image resolution, the featuer soft push button actuation styles are available in both 25K and
guys low profile pen design enables access camera makes every of the chuck mechanism and triple 30K frequency options.
access to hard to reach areas. and uses less workspace. Multiple shot superb. From port spray. Fits all standard 6 hole Compatibility with all magnetostric-
Rick Protected with a scratch-resistant, configurations will hold five to 18 Carestream Health Inc, fiber-optic tubing, compatible with tive devices. From Brasseler USA
eater sapphire-hard coating and teflon instruments. From PDT, Inc.— exclusive manufacturer of Kodak NSK type quick connect couplers. .
seal. From Clinicians Choice. Paradise Dental Technologies. Dental Systems. From Sable Industries. Circle #218 on feedback form
Circle #214 on feedback form Circle #215 on feedback form Circle #216 on feedback form Circle #217 on feedback form
rnia,
peo-
as all SmartLite Max LED Curing Light The NSK Nano400 combines user- ARESTIN (minocycline hydrochlo- The Air-Flow Master Piezon can ProDrive’s revolutionary upgrade
quite combines two LEDs in the tip for friendly ergonomic design with light- ride) microspheres is indicated as provide sub- and supragingival air turbine and triangular bur system
most multiple wavelength weight titanium. Weighs 61 grams. an adjunct to scaling and root plan- polishing as locks together for improved cut per-
output, covering tradi- Smooth, ning (SRP) procedures to decrease well as scaling, formance, control,
tional CQ based mate- quiet, power- pocket depth all in one unit. and precision.
paid rials and materials with ful, and ver- in adult Combats peri- Experience ProDrive
d Dr. initiators requiring a satile, the patients with odontitis and two ways, the
lower wavelength for Nano400 chronic peri- peri-implantitis; ProDrive Upgrade
activation. Features a features LED fiber optic micromotor. odontitis. A an LED light Turbine for leading
high output of up to Attachments are available for all simple and easy delivery system provides optimal visibility. brand handpieces, or
1400 mw/cm2, large curing area, specialty areas, the system can be with no preparation required before Magnetically secured to the side of the ProDrive High-
n for
four output modes, and a built-in easily integrated into any dental administration. From Johnson and the unit makes the tool easy to Speed Handpiece.
I’ve radiometer. Cordless or corded. delivery system. From Brasseler Johnson. remove and store. From EMS. From Patterson
n the From DENTSPLY Canada USA. Circle #222 on feedback form Dental.
teran Circle #219 on feedback form Circle #220 on feedback form Circle #221 on feedback form Circle #223 on feedback form
[for
and
drive
Therapeutic Spotlight Please circle the numbers corresponding to the product on which you wish to receive information
had The Picasso and Picasso Lite lasers combine ease-of-use, sleek 201 202 203 204 205 206
great design, and affordability. Offering convenience of disposable tips or low 207 208 209 210 211 212
cost strippable fiber. Perfect for a den-
tist’s first laser or for advanced laser
213 214 215 216 217 218
chat-
Las experts. The Picasso and Picasso Lite 219 220 221 222 223
lasers can perform a wide-range of soft-
Rod Please send me information concerning the products selected above
tissue surgical, periodontal, and
we endodontic procedures and are an ideal Your name..............................................................................................................................................................................................
pable replacement for electrosurgery. Sold Your practice address ..........................................................................................................................................................................
Your city, prov., code ............................................................................................................................................................................
him exclusively through Oral Science. E-mail address ......................................................................................................................................................................................
Circle #211 on feedback form You may... o request this material by e-mail: dentalproducts@chronicle.ws o request this material by fax: 1-800-865-1632
might o request this material by mail: Dental Chronicle, 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3

dered

Now: Get more information your way

ities,
ordi-

er, a

how Web site URLs for Dental Chronicle advertisers READER SERVICE
” Dr. For more information on these advertised products circle the corresponding product
CLE. Air Techniques http://www.airtechniques.com number. Visit http://www.dentalchronicle.info for more information
I did Air Techniques ......................................Acadia Amalgam Separator 201
AMD LASERS http://www.amdlasers.com
t and AMD LASERS ......................................Dental Lasersr 202
Bisco Canada http://www.biscocanada.com
e of Bisco Canada ........................................Endo Products 203
rt of Colgate-Palmolive http://www.colgateprofessional.ca
Colgate-Palmolive ..................................Sensitive Pro-Relief 204
y fit- Germiphene http://www.germiphene.com Germiphene ............................................AmalgamBOSS 205
an a GSK Inc. http://www.www.gsk.ca GSK Inc. ................................................Sensodyne 206
d do Henry Schein http://www.henryschein.ca Henry Schein ..........................................Air Techniques STS Dry Vac 207
Odan Labs http://www.odanlab.com Henry Schein ..........................................MidMark PowerVac System 208
rt of Oral Science http://www.oralscience.com Henry Schein ..........................................SolmeteX HG5 209
Periowave http://www.periowave.com Odan Labs ..............................................Rovamycine 210
Long
Sable Industries http://www.sableindustriesinc.com Oral Science ..........................................Picasso Laser 211
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Sable Industries......................................Utility Room 213
icle
Dental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:38 PM Page 26

DentalVitae
Ten minutes with... Dr.
Dr. Richard Souviron,
through his work on the Ted
Bundy case, has been responsi-
ble for demonstrating the practi-
cal use of bite mark analysis to
the U.S. judicial system. Since
the Bundy case in 1979, he con-
tinues to appear in court as an
forensic dentist and expert wit-
ness, exonerating the innocent
and putting away those he calls
the “bad guys.” He also operates
a private dental practice in Coral
Gables, Fla.
In April, Dr. Souviron was
invited to present a guest lecture
on forensic dentistry at Saint
Mary’s University in Halifax.
Richard Souviron
As Dr. Richard Souviron prepares to take a dental impression, the
patient, surrounded by police officers with a warrant, begins to yell.
Dr. Souviron asks the patient if he’s going to bite him, but the patient
replies in the negative. He says he’s a non-violent person.
That patient was America’s most prolific serial killer Ted Bundy,
and Dr. Souviron’s evidence helped convict him in 1979. A bite mark
on the neck of one victim was the only physical evidence linking
Bundy to her death, and Dr. Souviron was responsible for determin-
ing that Bundy made that bite, demonstrating the important and
practical use of bite mark analysis to the U.S. judicial system. .
What drove you to make bite marks admissable in a court of law?
I’d been working for, at that time, probably six or seven years with the
[medical examiner’s] office, and had done several other cases prior to
this one that involved homicide. [The bite mark on Lisa Levy] was a
pretty important link and in this case it was the only physical evidence
they had at the time. So I don’t know that I was any different than any
of the other forensics dentists in the country who wanted to use this
evidence as part of the criminal justice system.
You were responsible for making the public aware of this foren-
sic technique. How do you react to that?
I just happened to be in the right place at the right time.
Your expertise allows you to shed light on the justice system. Do
you consider this just a job, a way to pay your bills, or do you feel
a certain amount of pride?
Two out of three. (laughs)
Forensic science television shows are very popular now. Do you
feel you have to dispel the mythos around forensic science?
It’s unfortunate that a high amount of publicity surrounded the Ted
Bundy case, a unique situation with somebody who left a very clear
pattern and somebody with extremely unusual teeth. After that it was
extrapolated to say some people said it was good as a fingerprint,
some people said it’s better than a fingerprint. There are a lot of vari-
ables, a lot. It’s pretty impressive when you have a set of teeth and the
jury can literally take an acetate overlay and match it up to a bite mark
and they can see whether it fits or doesn’t fit. Then they have to arrive
at a decision whether or not this evidence along with everything else
is enough to convict beyond a reasonable doubt. But that’s just a piece
of the puzzle. There’s never one thing, it’s never a smoking gun.
What other cases were you most proud to be a part of?
In one case I was the only expert, and that was a case out of
Mississippi [involving] Kennedy Brewer, who did 13 years for mur-
dering a little girl. My testimony for the defense was that there
weren’t any bite marks on the body at all, no human bites, they
were all either insect or aquatic animal activity, but none of them
were human bites. And 13 years later DNA not only cleared him
of the crime but found the man who actually did do the murder.
The evidence was reviewed by numerous forensic dentists subse-
quently and they all agreed that none of them were bite marks, and
the odontologist that claimed they were has since been debunked.
He’s had four or five of his cases reversed, and it was just a terri-
ble blow. Whatever good was done by [the Bundy case] was
undone by this particular individual.

Which two? In this instalment of Dental Chronicle’s ongoing series of interviews

Of course you feel pride, and you feel you’re contributing to with notable clinicians and researchers, Dr. Souviron spoke with
the betterment of society by helping the criminal justice sys- assistant editor Josh Long. The editors invite your suggestions for
tem. It certainly isn’t a one man show that’s for sure, and it future subjects of this feature. Please e-mail your suggestions to:
doesn’t pay. dental@chronicle.ws

CBS News through records from child health and pub-

A study by researchers at the
NYU College of Dentistry suggests peri-
odontal disease may increase the risk of
What the lay press is saying lic dental clinics. The scientists cite parental
concern over weight development as one
reason why underweight children are at a
Alzheimer’s disease (Aug. 4, 2010).
During the study, a research team led by Dr. Angela Kamer, assistant professor high risk for tooth decay. Parents of underweight children do not want to deter their
of periodontology and implant dentistry, analysed data on periodontal inflammation children from eating, so they impose less restrictive dietary constraints. As a result,
and cognitive function from the Glostrop Aging Study, which has been gathering underweight children tend to consume diets that contain more sugar. According to
medical, psychological, oral health, and social data on men and women spanning a Lars Matsson, professor of pedodontics at the Faculty of Odontology at the univer-
20-year period ending in 1984. The scientists found that those with gum inflamma- sity, modified dietary habits are key to improving dental health.
tion were nine times more likely to
develop cognitive impairment than The Sheaf A University of Saskatchewan study says a toothbrush
those without. Dr. Kamer is currently produced in Japan effectively combats gingivitis and biofilm with-
working on a follow-up study involving out the use of toothpaste, according to an article in the universi-
a larger, more ethnically diverse group ty’s student newspaper (Sept. 8, 2010).
of subjects, to further examine the Called the Soladey-J3X and produced by the Shiken compa-
mechanisms that connect periodontal ny, the article says the toothbrush uses a titanium oxide semicon-
disease with cognitive dysfunction. ductor that runs through the middle of the toothbrush to give
off electrons that break down the matrix formed by bacteria in
The Local (Sweden) Researchers at biofilm. Though the rod doesn’t need to be replaced, the bristles
Malmö University in Sweden have found at the end of the toothbrush do wear, and require replacement
that underweight children are at three just as a regular electric toothbrush would.
times’ greater risk of tooth decay as are Dr. Gerry Uswak, the principal investigator for the study,
normal weight children (July 10, 2010). said in the article that this technology would be “especially bene-
For the study, researchers examined ficial for folks who, for whatever reason, can’t brush correctly.”
the dental health of more than 900 five- Dr. Uswak added the toothbrush could help people who cannot
year-olds in central Skåne, Sweden tolerate toothpaste.

26 n September 30, 2010 DentalChronicle

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