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Custom WHITENING trays in less than ONE hour

Oct. 1, 2003
By adding a single appointment tooth-whitening, tray-fabrication procedure to your routine hygiene schedule, you can have both your hygienist and assistant become income-producers.

by James DiMarino, DMD, MSEd and Susan DiMarino, RDH, BS

Patient demand for fast, effective, and safe tooth-whitening continues to escalate. With the Alfa (Alginate Full Arch) Triple Tray, you can provide your patients with tooth-whitening trays in a single visit. This tray records both the maxillary and mandibular impressions in a single step, along with the bite registration. You take one impression to record both arches and dramatically reduce the incidence of gagging because of the tray design. Impressions are poured and trays are fabricated at the same visit.

By adding a single appointment tooth-whitening, tray-fabrication procedure to your routine hygiene schedule, you can have both your hygienist and assistant become income-producers. The chart on the next page shows the reduction in steps necessary to take maxillary and mandibular impressions compared to other techniques.

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The reduction in steps using the Alfa Triple Tray will allow you to create and present bleaching trays in much less time than it would take to create the models using single-arch trays. This technique eliminates the need for a second appointment to provide the patient with the trays and tooth-whitening material. The Alfa Triple Tray will not only help you work smarter, but it also will reward you for your efforts by boosting the total income produced by the patient's visit. For more information regarding the Alfa Triple Tray, go to the free clinical tutorial at

Proposed scenario

The Alfa Triple Tray is loaded with alginate.
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When a patient arrives for his or her routine dental visit and expresses an interest in home-whitening procedures (or a member of your team suggests this) the assistant should seat the patient and immediately take an impression before the hygienist enters the operatory. With the Alfa tray, the assistant does not have to hold the tray in place while the alginate is setting. This helps speed up the process by allowing the operator to clean up the mixing bowl and put away the alginate while the impression is setting. Another great impression material is the new alginate-replacement material, Status Blue™ from Zenith/DMG and Position Penta™ from 3M ESPE. These are vinyl polysiloxane materials that cost about the same as alginate, but can be poured multiple times.

The Alfa Triple Tray is seated like a standard, full-arch impression tray.
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The assistant then pours up the maxillary impression with a quick-set stone such as TAK Earth Stone™, Snap Stone™ from WhipMix, or Speed Stone™ from Discus Dental. She then places a damp paper towel over the tray to maintain the integrity of the alginate and measures out the next pour of stone. The set time on a quick-set stone is as little as five minutes, so your assistant only has to wait a minute or two to pour up the mandibular impression after cleaning the mixing bowl.

The Alfa Triple Tray is automatically held in place while the patient is in occlusion, freeing the clinician up to perform other tasks.
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Meanwhile, the hygienist, who is now in the operatory, starts the procedure she is scheduled to do. The important key here is that with one mix and one tray seating, the assistant is out of the operatory and out of the hygienist's way. By the time the hygienist is in the room, the impressions are completed and the models are in the process of being poured. Within minutes of taking the Alfa impression, both arches have been poured up and are ready to be placed in the vacu-former to create the bleaching trays. The assistant trims the trays with a heated trimmer, and the bleaching trays are then completed and ready for presentation upon completion of the hygiene visit.

Both the mandibular and maxillary impressions are recorded simultan-eously.
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I use fast-set stone in my office because it is conveniently packaged, it sets quickly, and it provides great results. It is slightly more expensive than the regular-set stone, but that cost is offset immediately by the time-savings associated with delivering custom-bleaching trays at the same appointment. I also see increased revenue generated by performing additional tooth-whitening.

Benefits to your office

The financial equation is simple. What do you charge for take-home whitening and what are the costs involved in providing this service to your patients? Factor in the benefit that patients really appreciate the convenience of one-visit appointments. Allocating an assistant's time to turn that person into another income-producer in your office will provide immediate financial rewards for you. Do not take up costly chair time mixing and taking two single-arch impressions when your assistant can take both impressions simultaneously and get out of the way of your other income-producer, your hygienist.

When you further consider that the assistant does not have to clean, sterilize, and restock the metal single arch trays, you come out way ahead. This tray provides you with both the maxillary and mandibular impressions with much less chair time than taking the impressions separately, and can reduce expenses in the laboratory by eliminating the time it would take to clean/sterilize reusable trays.

What about in-office bleaching?

With the advent of one-hour, in-office tooth-whitening procedures comes a concern: How do you help your patients maintain their new, white smile? The Alfa tray is perfect for this process. Explain to them that you will be taking impressions to create bleaching trays for them to use for touch-ups at home. Follow the same protocol as described above, and present them with the finished trays, along with their "before" and "after" photos and one tube of take-home bleach. This is quick, easy, and you won't have patients calling you two-to-three months after the in-office whitening procedure, asking to come back in for an in-office touch-up.

Competing with OTC products

Despite the benefits of having custom made tooth-whitening trays made in a dentist's office and using a dentist-dispensed product, many dentists have lost revenue to OTC products. By utilizing this tray, patients can obtain their custom made trays while they are in your office and you can recapture the business that has been lost to OTC products. This approach can also encourage patients who has not yet decided on whether to whiten their teeth to perform this process to use your office because of the confidence they have in you as a dentist and the convenience of obtaining what they need in a single appointment, using only an additional five minutes of their time.

Ready to get started?

Your ability to provide your patients with professional tooth-whitening in a single office visit will be appreciated by your patients. The benefits to your office include:

  • Providing a service that patients appreciate
    * Increasing revenue through additional tooth- whitening
    * Eliminating a second appointment to deliver the trays to the patient
    * Creating efficiencies by taking both impressions simultaneously

To increase the number of tooth-whitening cases you perform, whiten the teeth of your staff members if you have not already done so. Their newly-created smiles will make them your best advertisement for tooth-whitening. Next, have the receptionist or your chairside assistant introduce the idea to patients when they confirm the hygiene appointment. Be sure and tell patients that they will be able to leave the office that day with everything they will need to start the whitening process.

With minimal effort, you can create more revenue from the single hygiene appointment. At the same time, additional chairtime will be available for you to do other procedures because the time it takes for the impression-making process has been dramatically reduced.

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