New practice for the new economy

April 1, 2009
There's no question that with the current economic state of the world, most dental offices have made changes in their procedural mix.

by Louis Malcmacher, DDS, MAGD

For more on this topic, go to and search using the following key words: Dr. Louis Malcmacher, Common Sense Dentistry, restorative dentistry, carbide bur instrument, matrix band, anesthetic, lab fees, profitability.

There's no question that with the current economic state of the world, most dental offices have made changes in their procedural mix. Most general dentists offer a number of different procedures in their offices, with an emphasis on cosmetic, implant, and reconstructive dentistry in recent years. Typical plain restorative dentistry has never seemed exciting to most general dentists because it is so bread and butter, and has modest fees attached to the procedures.

Most dentists realize that these day-to-day restorative procedures are the backbone of any general dental practice. When restorative procedures are performed efficiently, they are among the most profitable in any dental office. The reasons are clear — they are one-appointment dentistry with no laboratory fees. If it takes 10 minutes to do a three-surface composite resin on a tooth start to finish, then obviously the profitability factor is very high. If that same procedure takes 45 minutes per tooth, at some point a dentist is probably losing money.

In good times or in bad, restorative procedures are necessary and patients will pay for them. If someone has a cracked tooth or filling, that person needs to have the tooth replaced or extracted. Many patients in this economic climate may not go for a crown or an onlay, but they will chance a large direct restoration in that tooth and see what happens.

Here are three simple ways to make your common restorative procedures more efficient and profitable:

1 Deliver an anesthetic more quickly and more precisely. The STA (Single Tooth Anesthesia) System by Milestone Scientific is a must for every restorative dental practice. This easy-to-learn computer-controlled system delivers anesthesia on a tooth-by-tooth basis, and you can literally begin the procedure without getting up from your chair. Patients do not have a numb lip or tongue for the rest of the afternoon. This rates very high on patients' satisfaction scale. The STA system guides you through the process of delivering the perfect and comfortable periodontal ligament, AMSA, and PASA injections to the teeth that you want to anesthetize with no soft tissue anesthesia. Once you have an STA, you will not want to practice without it. 2 Use a brand new carbide bur instrument for every patient. I have been teaching this to my audiences at lectures for years. A brand new carbide bur will cut much more quickly, efficiently, with fewer postoperative symptoms, and it's much easier on the dentist's hands. Buying your carbide burs in bulk will keep them inexpensive enough so that you can use a new carbide bur on every single patient. Some of my favorites are the SS White carbide burs, Coltène Whaledent's Alpen burs, and Microcopy's complete line of NeoBurs and NeoDiamonds.3 Use the correct matrix band for each restoration. For amalgams, a Tofflemire band always produces predictable results. Use that with composite resin, and generally the proximal contacts are less than desirable. Dr. Simon McDowell, a dentist, developed the V3 Ring System by TrioDent. The new Composi-Tight 3Dsectional Matrix System by Garrison Dental Solutions was developed by Dr. Garrison. These systems have become the standard in tens of thousands of dental offices around the world. They are specifically designed for composite resin placement to produce a long, broad proximal area, and to deliver the perfect proximal contact. They are modified bitine nickel titanium ring systems, so they are incredibly intuitive to use, and a dentist can treat multiple teeth at the same time. This has cut the time and frustration of delivering posterior composite restorations in my office quite a bit and has saved much time.

Most dentists mistakenly think that an indirect procedure with a high fee is more profitable than restorative dentistry. Nothing could be further from the truth. Restorative dentistry ranks among the highest in profitability for every dental practice if the restorations can be done faster, easier, and better than before.

Restorative dentistry generally does not get the acclaim that the big cosmetic and implant cases get, but in this economy, you will be counting on restorative dentistry more than ever to create a healthy bottom line for your practice.

Dr. Louis Malcmacher is a practicing general dentist and international lecturer, author, and dental consultant known for his comprehensive and entertaining style. Contact Dr. Malcmacher at (440) 892-1810 or via e-mail at [email protected]. Go to for more information on his lecture schedule, audio CDs, to download his resource list, and to sign up for a free monthly e-newsletter.

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