Bonding The top 10 basics

With today’s public exposed to TV shows such as ABC’s “Extreme Makeover” and Fox’s “The Swan,” our patients have become more aware of their cosmetic options.

With today’s public exposed to TV shows such as ABC’s “Extreme Makeover” and Fox’s “The Swan,” our patients have become more aware of their cosmetic options. This demand has influenced general dentists and the direction clinicians must take. I have seen some dentists jump into the adhesive arena completely while others stay on the sidelines of the esthetic revolution.

Those dentists’ desires to stay on the sidelines are understandable because cosmetic dentistry can be intimidating. Dental technology is expanding at such a rate that it is almost overwhelming. Nano-filled composites, self-etch vs. total etch, zirconia vs. pressed ceramics, cementable restorations vs. bonded restorations - no wonder a lot of dentists fear change.

Manufactures are making techniques and materials easier to work with. Let’s look at adhesive dentistry. The No. 1 complaint is the misuse of phosphoric acid and the sensitivity it causes. Self-etchants are the future of adhesive dentistry. This will take the technique-sensitive phosphoric acid out of the bonding process. This technology is even being carried over into self-etchants in resin cements such as MaxCem (Kerr) or Unicem 3M/ESPE.

There are many missed opportunities in adhesive and metal-free dentistry. How would you like to add 15 percent to 25 percent to your bottom line without purchasing new equipment? Below I outline 10 things that have been successful in my practice for more than 10 years.

First - Invest in your education so you can feel comfortable with the esthetic procedures you want to do. When traveling to lecture, I notice that nearly all dentists list “Cosmetic and Family Dentistry” with their names in phone books. How many really know smile design and Golden Proportion? Whether from a hands-on course or other forms of education, learn to be the best at what you do. Confidence sells dentistry.

Second - Learn to photograph with a good digital camera that is easy for your team and you to use. Start collecting cases of work that your office has completed. This includes direct and indirect composites, all-ceramic crowns, and veneers. Patients love seeing before-and-after cases. I use my photo album daily to show patients the possibilities.

Third - Imaging systems for anterior and posterior work will create instant value in their future smiles. Do not depend solely on technology to sell cases, but use technology to help patients visualize their new smiles. Intraoral cameras also help patients visualize needed work. This is especially true with posterior amalgam replacement.

Fourth - If your team or you need anterior or posterior dental work, get it done. How can one of your assistants talk about how great direct or indirect composites are when quadrants of amalgams in her mouth need to be replaced? Worse are dentists with less-than-ideal smiles who try to create value with patients. I had eight veneers placed several years ago because patients kept looking at my rotated central incisor and my discolored teeth. Now I can smile at patients and say, “I believe in this so much that I also have veneers.”

Fifth - Update your facilities. You do not have to have a dental spa, but every five years refresh your office with new furniture, a coat of paint, or new carpet. Notice how you feel when you go into a nice showroom such as a Lexus dealership vs. your local Ford dealership? Being in a clean office with the latest technology makes people feel good.

Sixth - Help your patients finance treatment. Provide alternative financing because most insurance companies do not provide benefits for adhesive dentistry. Insurance companies prefer to pay for amalgams rather than composites. My office accepts numerous credit cards as payment, but we accept outside financing for dental work. A local company provides some of our patients with 12-month, interest-free financing. The rate they charge dentists for the service is negotiable. For larger cosmetic cases, we recommend CareCredit, Dental Fee Plan, and HELPcard. Most of these third-party companies will finance up to $25,000. Unfortunately, today’s society asks, “How much will this cost per month?” and “Can I fit this into my budget?”

Seventh - Market your practice internally and externally. With saturation of cosmetic dentistry, clinicians might want to explore internal and external marketing. Television, radio, magazines - there is no magic bullet. Every market is different, so practices must track results. External marketing is expensive, but it can be effective.

Eighth - Every practice needs a coach. As good as Tiger Woods is at golf, he still has a coach to help him improve. Someone from the outside comes in to our practice at least once or twice a year to help us improve our techniques. Every office picks up bad habits and gets stagnant. A good coach will motivate your team.

Ninth - Continue to learn. This might sound like No. 1. Many dentists go to one hands-on course and then stop. Dentistry is changing rapidly, so form a small study club of dentists in which you can express problems and solutions to obstacles we all have. I have belonged to a group of seven dentists from the southeast. Through phone conversations or annual meetings, we accomplish much because our concerns are similar.

10th - Be patient. Education, marketing, or any of the aforementioned will not bring immediate success. Visions develop into realities with time. It took years to transform my practice to an esthetic-based practice, and I still have to work hard to maintain my vision.

This is the golden age of dentistry. We are continually reminded of the aging baby boomers and their desires to look younger. By 2010, one-third of the U.S. population will be baby boomers. You can accommodate the vast patient potential.

Dr. Stephen D. Poss has served as clinical director at the Las Vegas Institute for Advanced Dental Studies since 1998. He received his DDS from the University of Tennessee and has received extensive post-­graduate training from Baylor University of Contemporary Aesthetic Diagnosis and Treatment in Dallas. He maintains a practice in Brentwood, Tenn. E-mail him at

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