Low-cost dental strategies with BIG payoffs

How do you save time in a time-starved, quality-conscious world?

How do you save time in a time-starved, quality-conscious world?

According to various manufacturers, the purchase of digital radiograph systems, lasers, and paperless charting software will propel us to time efficiency nirvana. However, these items require large capital investments, steep learning curves, and do not necessarily enhance the quality of our care. By contrast, the dental marketplace also is replete with dental instruments, materials, and procedures that are financially within the reach of every dentist. As an added benefit, these items can actually enhance the quality of our treatment.

First and foremost on my list of low-cost, quality-enhancing dental techniques is the innovative combination of a specific impression material and a specific impression technique called the H&H technique. This technique, which was developed by Dr. Jeffrey Hoos, requires the use of a hydrophobic impression material, such as Perfectim Blue by J. Morita, combined with a triple tray, such as the Quad Tray by Clinicians Choice. This technique makes the need for retraction cord unnecessary yet results in an exquisitely detailed crown and bridge impression in a predictable fashion. For the prosthetically oriented dental practice, the time savings are enormous and I have found the consistency of high-quality impressions to be superior to traditional techniques that use retraction cord and hydrophilic impression materials.

Recent advancements in resin cement technology have provided resin cements, such as MaxCem by Kerr and Unicem by 3M, that self-etch and self-prime. This feature yields several simultaneous advantages. First, since the etchant never penetrates the dentin beyond the primer, postoperative sensitivity is virtually eliminated. Second, since the separate steps of etching and priming are precluded, there is less chance of tooth surface contamination immediately prior to and during the cementation process. MaxCem has the added advantage of a self-mixing cartridge.

Resin cements offer higher bond strengths, less microleakage, and nearly zero solubility in oral fluids as compared to nonresin cements. However, all resin cements require a clean tooth surface in which to be bonded. Debris, mucopolysaccharides, and remnants of temporary cements left on the tooth surface all diminish the quality of the bond between resin cements and dentin. A device designed for eliminating this surface contamination is the OptiClean bur by Kerr. This bur was designed with a specific size, shape, and abrasiveness for thoroughly cleaning a prepared tooth after removal of a temporary crown and prior to cementation of a final crown. Opticlean accomplishes this without altering the size or surface topography of a prepared tooth. In fact, an entire quadrant of prepared teeth can be cleaned, thus affording an optimal tooth surface for bonding in only a few seconds. Having said this, please be advised that I am the inventor and original patent holder of this product. Due to my royalty agreement with KerrHawe, I have a financial interest in OptiClean.

One of my favorite new devices is a software program called SNAP by Snap Imaging Systems, Inc. After a digital image of a patient is captured via digital camera, SNAP facilitates the upload of that image to a computer. The device then allows the user to manipulate the image to create a beautiful looking smile and print a “before-and-after” color print - all within three minutes! The incredible speed of this process allows the showing of these photographs during a patient’s first visit while he or she is still in the chair. This results in a powerful and fascinating experience for an esthetic-conscious patient. SNAP has made this service so streamlined and intuitive that staff can master the process within 10 minutes. SNAP not only provides a great service to your patients, but it also provides endless fun for the staff.

The enhanced efficiency that nickel-titanium rotary files bring to endodontic procedures is well-established. Endosequence files by Brasseler are a quantum leap in technology as compared to the first generation NiTi files. Their unique, asymmetrical thread geometry - combined with a highly polished surface - reduces the torque that a file must sustain. This, in turn, provides not only increased filing speed, but reduced file separation, too.

Also in the endodontic realm are electronic apex locators such as the Root ZX by J. Morita. Many studies have demonstrated that these devices are more accurate than radiographic guide file films. As such, they preclude the need for the time-consuming process of exposing and developing these radiographs. Dentists who perform endodontic treatment can benefit from both the accuracy and the speed of this device.

When used for the primary injection, intraosseous anesthetic injections provide predictable and nearly instantaneous anesthesia for the mandibular dentition. When the conventional inferior alveolar nerve block is not effective, the intraosseous injection is a dependable back-up. The X-tip provides the necessary armamentarium to carry out this useful technique.

The FDA approval of four percent articaine local anesthetic allows more time-efficient dental procedures because of its reduced onset time. Dentists also report more profound levels of anesthesia as compared to conventional local anesthetics. Articaine has become the favorite anesthetic among dentists in my practice, and is gaining market share rapidly.

Finally, a philosophy of treating multiple teeth, or even multiple quadrants within a single appointment, can yield tremendous advantages in time efficiency and materials. Between consumable materials and staff wages, I figure that it costs from $40 to $45 to prepare one of my operatories between patients. If I were to perform four restorations within one appointment, my turnover cost is $40 to $45. If I completed the same four restorations in four separate appointments, my turnover costs would be $160 to $180. Since our patients live in the same time-starved world that dentists do, they appreciate being able to complete dental treatments in fewer visits. Costs for subsequent visits can be substantial. Thus, front desk staff should become skilled in determining accurate co-payments while offering patients appropriate payment and financing options.

The list of devices and procedures I have discussed are by no means exhaustive. In fact, inexpensive and innovative dental products and procedures are being introduced at a feverish pace. This is a boon to dentists as well as patients. I think that one of the most exciting aspects of dentistry is the researching, utilization, and implementation of new products and procedures into a practice. Besides improving efficiency, I have found this type of activity mentally stimulating for my staff and me, image-enhancing for the practice, and - most importantly - quality-enhancing for my patients. Also, because these products are so inexpensive as compared to other items - such as lasers, digital radiography, or microscopes - it is not a financial catastrophe if I decide that I just do not like a particular product or technique, or that it cannot be implemented appropriately into the practice. My staff and I find this activity to be more fun than work.

Many of these advancements also make the physically demanding practice of dentistry just plain easier and less stressful. This, in turn, can improve our personal lives and perhaps, even extend our careers!

Dr. George Salem maintains a private, fee-for-service dental practice in Braintree, Mass. Founded in 1989, the practice has grown into a multispecialty group office that employs periodontal, orthodontic, and oral surgical specialists. The practice provides management of dental patients with simple to highly complex reconstructive and cosmetic needs. He is a Fellow of the Academy of General Dentistry, and author on practice management, patient management, and prosthetic techniques. He is also the inventor and original patent holder of the Kerr OptiClean® dental bur. Contact Dr. Salem by e-mail at gtsalem@comcast.net.

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