77002 AurContNL Spok Vol15-2:G399€¦ · 2 CONTENTS In the News Advanced Esthetics —Precision and Esthetics with IPS e.max® CAD and Core 3d Centers™ Dr. John Krasowski Grant

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77002 AurContNL Spok Vol15-2:G399 6/9/11 11:39 AM Page 1

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CONTENTSIn the News

Advanced Esthetics — Precision andEsthetics with IPS e.max® CAD and Core 3d Centers™

Dr. John KrasowskiGrant Maier

Digital Dentistry — Cadent Itero™ Digital ScanningDr. Tim Chaisson

Case Spotlight — Dr. Ted Reavley

Hot Topics — Treating The Dreaded “Black Triangle”Dr. Louis Malcmacher

Cast Partials — Troubleshooting CastPartials: Challenges and SolutionsGary Wakelam

Innovative Implant SolutionsDr. Robert Dores

Digital Dental Benchmarking:What do the numbers say?Vijay Sikka

Appliance Therapy — Molar UprightingThe Most Neglected Treatment inDentistry (Part 2)Dr. Rob Veis

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IN THE NEWS

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© Aurum Ceramic Dental Laboratories LLP (2011).Reproduction of this work in whole or in part by any means whatsoever is strictly prohibited

without the express written consent of Aurum Ceramic Dental Laboratories LLP. All rights reserved.

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Pictorial Profile — Mary Walsh-Cole

Consultants Corner — Dealing WithDifficult People Sherry Blair

In today’s electronic age, every now andthen, a mailing list goes wrong.Unfortunately, this has happened with ourlast issue (Winter/Spring 2011) ofContinuum. Many of you received mis-labelled newsletters, others apparently did not receive any newsletter at all.

At this point, all we can do is offer our sincere apologies for any confusion andinconvenience this may have caused. If youdid not receive your copy of the Winter/Spring 2011 Continuum, and would like toview it, the newsletter is available on-line asthe “Current Newsletter” off our News &Events Index at our websitewww.aurumgroup.com.

(Direct link: www.aurumgroup.com/newsevents/currentnewletter.cfm).

We’re Sorry!


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ADVANCED ESTHETICS

Through recent advancements inCAD/CAM technologies andmaterial sciences, dentists and

laboratories now have the ability to create precise restorations that offer thebest in fit and function. Collaboratingwith laboratories utilizing advancedtechniques, dentists can now expectrestorations to demonstrate improvedfunction and the durability required toresist masticatory forces. Developedwith the patient in mind, restorationscreated in the dental laboratory of todayprovide the best in function, esthetics,and comprehensive care.

A leader in providing the latest in digital technologies for ComprehensiveAesthetic and Implant Dentistry, Aurum Ceramic Dental Laboratories (aurumgroup.com) is committed to supporting dentistry with the most technologically advanced materials andtechniques. They have partnered withCore 3d Centers and Ivoclar Vivadent togive your patients the aesthetic and highstrength all-ceramic restorative solutionsthey demand. Applying high-technologyfive-axis precision industrial millingtechnology to restorative dental cases,Core 3d Centers (core3dcenters.com)offers a unique global service throughcollaboration with leading dental companies on three continents. Throughdynamic, precision, and intelligent laboratory development, a constantlyevolving and wide range of restorativesolutions are offered to customers withimproved precision, fit, and the ultimate

Precision and Esthetics with IPSe.max® CAD and Core 3d Centers™

John Krasowski, DDSGrant Maier, BBA, CDT, RDT

in quality care for patients. Core 3d isalso officially validated with IvoclarVivadent.

Whether using a 3D intraoral scanneror traditional impressions, monolithiclithium disilicate restorations milled byCore 3d offer highly esthetic anddurable all-ceramic restorations, withsuperior fit, for a variety of indications.In cases requiring single or full-mouthrestorations, monolithic lithium disili-cate restorations milled by Core 3d alsoallow dentists the choice of adhesivelybonding or conventionally cementingintraorally. By providing the best in tech-nology and material sciences, dentistswho have partnered with Aurum, alongwith their strategic partner Core 3d, canoffer their patients the best in esthetics,function, and care.

The case presentation below demon-strates how a successful restoration of a patient’s dentition was completedthrough the collaboration and communication of the dentist and dental laboratory, utilizing advancedtechniques.

Case PresentationA female patient in her mid-40s presented to the office with chronic painthat she had been suffering from forover 20 years. The patient displayedmultiple signs and symptoms typicallyassociated with airway and neuromuscu-lar occlusal disease. Prior to coming tothe author’s practice, the patient hadbeen treated for many years with splintsand other treatment modalities that hadbeen unsuccessful.

Treatment PlanningOf the patient’s conditions, the anteriorteeth were also flared due to a tonguethrust and canting from left to right waspresent. The patient also demonstratedbicuspid drop-off, incisal wear, and lingually inclined posterior teeth.Therefore, the treatment plan wouldinclude a neuromuscular orthotic.

Since the patient was a professionalin the public eye, it was necessary to

John Krasowski Grant Maier

provide her with an esthetic result thatalso allowed her to function on a day-to-day basis, without compromising herability to speak. After discussing varioustreatment options with the patient, itwas decided that initial treatment with afixed orthotic would correct for thecanting and level the occlusal plane tothe cranial base or hamular notch toincisive papilla plane (HIP). This alsoallows for the mandible and associatedmuscles to function within the “Zone ofComfort” and continued healing withinthe stomatognathic system. By restor-ing the upper teeth at this time withlithium disilicate, a better, more stablefoundation was created.

Laboratory Protocol1. After receiving the necessary case

information from the dentist, the laboratory technician created awaxed-up model of the restorations(Figure 1).

2. The monolithic lithium disilicaterestorations were then created (IPS e.max® CAD, Ivoclar Vivadent,Amherst, NY) utilizing CAD/CAMtechnology and placed on the modelin their blue state (Figures 2 and 3).

3. The restorations were then cutbackto form the anatomical and structuralcharacteristics required of the case(Figure 4).

4. The lithium disilicate then under-went bisque baking to complete therestorations, which were then sent tothe dentist for final seating (Figures5 through 7).

Clinical Protocol1. After removal of the transitional

restorations, the monolithic lithiumdisilicate restorations (IPS e.max®

CAD) were inserted (Figure 8). Therestorations displayed excellentincisal translucency and texture,while the supragingival marginswere indistinguishable from naturaltissue profiles. The anatomy and


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Figure 1. The case was waxed-up case on themodel.

Figure 2. A frontal image of the monolithiclithium disilicate restorations was taken whilein their blue state on the model.

Figure 5. A frontal view of the upper monolithiclithium disilicate restorations after undergoingbisque bake.

Figure 6. Another bisque bake was completed,with the restorations on the table.

Figure 7. The lower monolithic lithium disilicaterestorations on the model.

Figure 8. Tissue irritation was corrected post-operatively with the fixed orthotic in place.

tooth shapes were successfully developed and the tissue was healingwell (Figures 9 and 10).

2. With the lower orthotic in place, thecompleted monolithic IPS e.max®

CAD lithium disilicate restorationsunderwent final cementation (Figure11). The margins were then cleanedof any excess material and displayedexcellent marginal adaptation (Figure 12).

3. An initial coronoplasty was completedto the patient’s fixed lower orthoticand good contacts were formed onthe lingual cusps (Figures 13 and 14).

4. A second coronoplasty was then completed (Figure 15). After 24hours, the dentition demonstratedbeautiful incisal translucency andexcellent arch form, tissue response,and interproximal contact (Figures 16and 17).

5. Since the patient had an extensivehistory of plaque and calculous build-up, recall intervals of 8 -12 weekswere needed prior to restorative treatment. Due to the bacteriostaticeffect, however, this was no longernecessary. The plaque build-up wasstopped and the gingival tissue washealing beautifully. Therefore, thepatient could return to a normal recallschedule of 3 – 6 months. At thispoint in treatment, the incisal translucency and characteristics alsodemonstrated a very natural appear-ance (Figure 18).

Figure 3. A blue state occlusal view of therestorations on the model.

Figure 4. The restorations were initially cutbackon the model, while still in their blue state.

Conclusion

Through the use of advanced techniquesand collaboration with the dentist, thelaboratory was able to develop durableand proper fitting restorations that couldbe placed easily intraorally. Demon-strating excellent fit and function, anddisplaying esthetics that mimicked thesurrounding dentition, the patient wasvery pleased with the results in this case.By utilizing CAD/CAM technologies,like those employed by Core 3d andAurum Ceramic Dental Laboratories, thedentist provided the patient with restora-tions that demonstrated the fit, function,and esthetics required of the case, aswell as the best in comprehensive dentalcare.

Core 3d can offer their patients the bestin esthetics, function, and care.


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Figure 18. The incisal translucency and characteristics of the restorations mimickedthose of natural dentition.

Figure 9. The restorations demonstrated excellent translucency and texture, while thesupragingival margins were indistinguishable.

Figure 10. A close-up view of the properlyformed anatomy and well-healing tissue.

Figure 11. The monolithic IPS e.max® CADrestorations underwent final cementation anddemonstrated proper marginal adaptation.

Figure 12. With the orthotic in place, finalseating was completed.

Figure 13. A photograph of the monolithic IPS e.max® CAD restorations inserted in theoral cavity was taken 24 hours after the firstcoronoplasty appointment.

Figure 14. The gingival tissue was healing well postoperatively, and the lithium disilicaterestorations displayed good contacts on the lingual cusps.

Figure 15. The monolithic lithium disilicaterestorations, prior to a second coronoplasty.

Figure 16. A full arch photograph was taken,showing beautiful incisal translucency, andexcellent arch form, tissue response, and interproximal contact.

Figure 17. A lingual view of the incisal characteristics, translucency, and margins onsupragingival preparations.

Dr. Krasowski is a Clinical Instructor and Regional Director at the Las Vegas Institute for AdvancedDental Studies. He has attained LVI Fellowship status. Dr. Krasowski is a regular contributor to manyDental Journals, and his work has been featured in numerous dental product advertisements and publications. He is a personal mentor to hundreds of dentists regarding conservative Neuromusculartreatment. Dr. Krasowski maintains a private practice in Wausau WI.

Grant Maier is the Laboratory Manager of Aurum Ceramic @ LVI (specializing in NeuromuscularDentistry), and VP of Core 3d Centers, USA (comprehensive dental restorative and implant superstruc-ture manufacturing). Upon graduating from Schiller International University in 1995 with a Bachelor ofBusiness Administration in International business, he completed his apprenticeship in dental technologyand achieved his RDT and CDT accreditation. At LVI, Grant has been directly involved with the AdvancedAnterior (Core 2) and Comprehensive restorative (Core 5) programs since 1998, and the Full Mouthrestorative program (Core 7) since 1999 (when it was founded). In June 2003 Aurum developed a trulyunique dental laboratory, for which Grant moved from Aurum Ceramic’s head office to open AurumCeramic @ LVI – a laboratory that provides fixed restorative, all-ceramic restorative solutions. Grant continues to oversee operations in Las Vegas as well as being involved with LVI’s restorative and implantprograms.


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Now, despite all of these potentialareas of inaccuracy, most cases go quitewell. The problem with conventionalrecord making practices is that whenthings go wrong, it is very difficult todetermine where the problem occurredand therefore make improvements inyour materials and techniques.

So, the next time you are mutteringunder your breath and running behind,while you’re frustratingly fiddling withrelief, contacts or grinding beautifullyglazed porcelain . . . instead of cursingthe lab, take this advice.

Look carefully at the case on themounted models. If occlusion, contactsand marginal integrity are perfect on themodel, how come they are not clinically?Inspect all models and impressions andtry to identify the reasons for clinicalinaccuracy. Be honest with yourself andfair to the lab. Then, phone a friend whois enjoying Itero and ask them if you canuse their operatory the next time theytake the day off. You won’t regret it.

You are likely wondering what led tothe two remakes we experienced. Theanswers were very simply acquired.Remake “forensics” are very predictablewith digital scanning. Aurum Ceramicsand I both agreed that the remakes weredue to human error. In one instance thescan was misread at the laboratory. Theother was entirely my fault. I attempted ascan with gingival bleeding. The patientwas from a fair distance away and,instead of temping and allowing thepatient to heal; I rushed into the scan tosave my patient from further travel —killing my procedure with kindness. Thelab didn’t bill me for the remake for thaterror on my part, so I didn’t hold themresponsible for the misread scan. That’sall part of The Itero Happiness Factor aswell.

DIGITAL DENTISTRY

Tim Chaisson, DDS

In the last issue of Continuum, I wroteabout what I call the “Itero HappinessFactor”. For the first time in my 25

year career, our fixed prosthetic remakepercentage was absolutely ZERO overmore than 100 cases (the two remakes Imention in the title? I’ll explain thoselater). Adopting Digital Scanning has notonly increased practice profit but hasactually created happier patients and clinicians.

While pondering our good fortuneone day, I was struck by a revelation. Mypartners and I went from what wethought was a normal but frustrating per-centage of remakes to no remakes at all.How did this occur? After all, the lab wasthe same. The answer to me is obvious. Itwas the incorporation of the Itero digitalscanning system into our practice. Moreimportantly, I came to the realization thatmy previous remake percentage wasmost likely the fault of our recording systems and not the lab.

For years, some crowns, bridges andveneers we received were not perfect. Iwould immediately condemn the lab andinform the patient about their incompe-tence, hoping it would keep them fromquestioning mine. I would then informthem that they would have to take moretime from their busy lives and return tobe poked, prodded, corded, impressedand temped again.

Now, Aurum Ceramic has nevercharged me for remakes. After all, howwould one ever determine where thefault should lie? I am now convinced,thanks to the Itero, that inaccuracies inrecords I sent led to the lion’s share of

124 Cases To Date, 2 Remakes!!!

the remakes we experienced. I thankthem for taking the highest road and notcharging me.

When I think of our previous pros-thetic recording methods I wonder howanything ever fit. We were likely lucky toenjoy the relatively low, yet frustratingremake rate we experienced.

Let’s just review everything that wasgoing on in my practice “pre-Itero”. First,you have the PVS manufacturers promis-es of low distortion and excellent stabilityover time. Has anyone ever tested thesematerials at 35000 feet, freezing in thebelly of an airplane??? What about yourassistant’s strict adherence to manu-facturer’s powder to liquid ratios when mixing stone for opposing models? Thenwe have to consider proper pouring, vibration and storage of these records(almost impossible to do that consis-tently each impression and model). Whatabout the effects of transportation onthese materials? Occlusal registrationmaterial and face bow records are farfrom perfect. Anyone who has had tohand articulate a case knows what I mean.

When I was pulling this article together, I asked the people I deal with atAurum Ceramic to outline some of the difficulties in record transfer they experience for me. We ended up with apretty lengthy list. The shortened versiongoes something like this:• Impressions with poor margins.• Impression trays with less material than

required.• Half arch impressions, when only full

arch would be acceptable.• The delivery of 3 or 4 inaccurate

impressions assuming they can beadded to make one good one.

• Distorted, incomplete occlusal records.• Opposing models that are distorted,

soft and porous.• Face bows that are loose and move

during transportation.• Incomplete and confusing prescriptions.

I used to do some of these things with-out thinking about it – what about you?

Cadent Itero™ DigitalScanning

Dr. Tim Chaisson graduated with his degree indentistry from Dalhousie University in 1985. Anative of Saint John, New Brunswick, he returnedto his hometown to practice general dentistry following his graduation.


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Restorations fabricated by Aurum Ceramic®.

“This young lady, now 17 years of age, hasbeen a patient of this office for severalyears, as has her mother. She was self-conscious about her smile because, althoughher lower arch was normal, she had espe-cially small maxillary anterior teeth alongwith some spacing issues. We had discussedtreatment with mother and daughterregarding veneering options. Orthodontics

had been done several years earlier but did not solve the issue ofher small teeth, so both expressed interest in Aurum’s Cristal®

minimum prep veneers. We then went into some detail as to howmany of her teeth should be restored, agreeing that with her smileline, bicuspid to bicuspid (#4-13) would be the best in her case. Inaddition, as we discussed her Smile Design, we agreed thatrounded cuspids, slightly shorter laterals and centrals rounded onboth corners would provide the most natural result.

Aurum Ceramic’s AE (Advanced Esthetic) Team prepared anupper Diagnostic Wax-up showing patient and mother her newsmile, which was eagerly accepted. A lower bleaching tray wasprepared for her to wear. At her next appointment, we preparedand temporized her dentition using Prep Indices, Bite Stent andSiltec Provisional Stent from Aurum Ceramic. The impressionswere sent to Aurum Ceramic along with photos for the fabricationof the Cristal® veneers. We chose Shade 030, which blended beautifully with her remaining dentition upon placement.

At her recall appointment two weeks later, the patient wasextremely happy with her new smile, her bite was perfect and shewas not experiencing any sensitivity. As you can see in her Beforephoto, her smile at that time was perhaps a bit tentative. What adifference in her After photo! Her face just lights up.”

Ted A. Reavley, DDS

Pre-operative upper arch.Retracted pre-operative smile.

Full face After.

CASE SPOTLIGHT

Full face Before.

Ted A. Reavley graduated from University ofMissouri @ Kansas City School of Dentistry in1978, joining his father, Dr. Jack Reavley, in private practice in Lamar, Mo. As a result, theReavley name has been in dentistry for over87 years in Barton County, Missouri. Dr. Ted

Reavley’s sons and son-in-law are following intheir father’s and grandfather’s footsteps with Dr. BrentonReavley graduating in June 2009 in Endodontics; Dr. BrianReavley graduating in 2011 in General Dentistry; and

son-in-law Dr. Michael McNaught graduating in 2013 in OralSurgery.

Dr. Reavley has made a commitment to employing continu-ing education and the latest technology to provide optimumdental health. He began taking courses at the Las VegasInstitute for Advanced Dental Studies (LVI) in the early 1990’sand has continued on through the Core 4 program. He wasfirst introduced to Aurum Ceramic at the outset and “hasappreciated their work since that time”. Dr. Reavley is a member of IACA, ADA and the Missouri Dental Association.

Close-up of new smile Retracted restored smile.


HOT TOPICS

Dr. Louis Malcmacher

Treating The Dreaded“Black Triangle”

• Adding lip and perioral volume aroundthe mouth for retention of removableprosthodontics

In terms of these therapeutic uses statedabove, nearly every state in the UnitedStates and a number of Canadianprovinces allow these uses of Botox anddermal fillers, because they are used forthe practice of dentistry as defined bythe dental practice act. Many of thesetherapeutic uses of Botox and dermalfillers are actually quite exciting for dental practitioners because they willhelp tackle some of the most difficultclinical situations that we are often confronted with.

As an example, TMJ and facial painhave haunted dental practitioners foryears and are among the most frustrat-ing cases that we deal with. Studies showthat as many as 85% of these cases aremostly muscle related. We, as dentists,have concentrated our treatment on theocclusion and teeth first and the muscleslater. It is now time to completely rethinkthis treatment progression. Using Botoxtherapeutically for facial pain and TMD,we can eliminate the pain coming fromthe muscle pathology first to see howmuch of that is a factor and at that point,we may go ahead and then treat theocclusion or the actual joint much moreeasily and accurately than ever before.

The dreaded “black triangle” usuallytops the list of dentists’ frustrations afterthe placement of crowns, bridges andespecially implants or after periodontalsurgery. After treatment, the patientfinally has ahealthy periodon-tium or a nicenew tooth sur-rounded by twobig black holes oneither side of it,which the patient whistles or spitsthrough or catch-es food in. Whilethe patient shouldbe thrilled thatthey don’t have to

There is no question that Botox anddermal fillers are well known forthe esthetic results they deliver in

terms of smooth skin and replacing lostvolume in the face, especially in the oraland peri-oral areas. Botox is essentially amuscle relaxer while dermal fillers, suchas Juvederm and Restylane, are volu-mizers or plumpers. Once you have beentrained on these procedures and under-stand thoroughly the anatomy, physio-logy, pharmacology, how to deal withadverse reactions, and everything elsethere is to know about them, then youwill find many, many therapeutic uses indentistry for both functional and dental esthetic purposes.

Here are but a few examples of thera-peutic uses for Botox and dermal fillers:

A. Botox dental therapeutic uses• TMD cases• Bruxism and clenching cases• Facial pain cases including treating

trigger points • Treatment of angular chelitis • Gummy smile cases• Orthodontic relapse and depressed

orthodontic appearance • Reducing muscle hyperactivity for

retention of removable prosthodontics

B. Dermal filler dental therapeuticuses in the nasolabial folds, lips,mentalis fold and labialmental foldsinclude the following:• Gummy smile cases• Establishing esthetic dental lip lines

and smile lines in esthetic dentistrycases as an alternative to gingivecto-my, crown lengthening and veneers

• Treatment of angular chelitis• Eliminating “black triangles” between

teeth after periodontal and implanttreatment that did not preserve thepapilla

• Reestablishing lip volume for properphonetics (in addition or as opposed toteeth lengthening with fixed or remov-able prosthodontics)

wear a flipper any more, they are disap-pointed at the esthetic results becauseof the lost tissue. What are our options?We can bond to adjacent teeth; we canredo the crown, remove the implant andtry again with a new implant; or otherfrustrating treatment options that arevery aggressive which may or may notwork. The placement of dermal fillers inthese areas to literally plump up papillais a minimally invasive way to createproper gingival contours.

Let’s take a look at this case below.Figure 1 shows the pre-op photo of apatient who has two all ceramic crowns(e.max® by Aurum Ceramic) on teethnumbers 8 & 9 and some beautifulno/minimal prep Aurum’s Cristal®

Veneers (Aurum Ceramic). The crownon tooth number 9 is loose and the radiograph in Figure 2 shows why, thetooth has fractured at the gum line.Figure 3 shows the new implant restora-tion in place. The dreaded “black trian-gles” in figure number 4 are one of themost challenging esthetic problems wedeal with all the time. Compare that toher original pre-op picture again in fig-ure number 1 and you can see why itbothers her. In addition to that, nowfood collects in these areas as well aswhen she speaks, she finds herself, inher words, “spitting while I talk”, whichshe has never done before. She lovesand hates her new implant all at thesame time.

We treated her with a diode laser(Picasso Lite, AMD Lasers) to loosen

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Figure 1.


the gingival attachment and then placedsome dermal filler (Juvederm Ultra PlusXC, Allergan Corporation) into the papilla to rebuild it. Figure 5 shows therebuilt gingival papilla, which fills up theblack triangles and takes care of heresthetic and functional concerns. Thetreatment appointment was approxi-mately five minutes and she can expectthis outcome to last for 8 months orlonger at which point it will have to bedone again. This is very minimally inva-sive approach to a very difficult situationand it completely satisfied this patient.

One more example is this nextpatient that comes in with a very com-mon dental complaint in Figure 6. If youlook carefully you will see that thispatient has an asymmetrical gummysmile. What are our choices here?Orthodontics is a choice, but this is anorthodontic case that most orthodontistsdon’t even want to tackle. We could sendthis patient to an oral surgeon to accom-

Louis Malcmacher DDS MAGD is a practicinggeneral dentist and an internationally known lecturer, author, and dental consultant known forhis comprehensive and entertaining style. An evaluator for Clinicians Reports, Dr. Malcmacher is president of the American Academy of FacialEsthetics. You can contact him at 440 892-1810or email [email protected]. His websiteis www.commonsensedentistry.com where youcan find information about his lecture scheduleand botox and dermal filler training, no prepveneer DVD, audio cd’s, download his resourcelist, and and sign up for a free monthly e-newsletter.

Editor’s Note: Please check with your localGoverning Board regarding offeringBotox/Dermal Filler services in your practice.

plish a maxillary LeFort I fracture andphysically move the maxilla up, thenhope that the mandible actuallyoccludes into it. Certainly, the way thatmost dentists would treat this is withsurgical osseous crown lengthening followed by crowns or veneers. Now wehave a proven and safe minimally inva-sive fourth option with an appointmentthat takes 15 minutes and the use ofBotox and dermal fillers. Figure 7 showsthe patient postoperatively having full lipcompetency, proper lip and smile linesand an esthetic result that will rival anyof the other dental options without pick-ing up a drill or scalpel. While this treat-ment will need to be repeated over time,the use of Botox and dermal fillers forthe use of soft and hard tissue dentaltherapeutic esthetic cases is as muchdental treatment as any of the otheroptions previously mentioned.

It is our legal and ethical duty to givepatients all of the options available for

their dental treatment. In this day andage, to do that, we as dentists need toget trained in the use of Botox and der-mal fillers as these are well-establishedviable dental treatment options. Thetreatments described in this article clear-ly fall under the definition of dentistry innearly all of the state dental practiceacts. Now that dentists understand theuse of Botox and dermal fillers in den-tistry for therapeutic and dental estheticcases and have become proficient intheir use through proper training, wecan now offer them in conjunction with,or in addition to, our current treatmentoptions to patients. These options rival,and many times surpass, many of thedental therapeutic outcomes now avail-able for both routine and challengingdental treatment cases.

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Figure 2. Figure 3.

Figure 4. Figure 5.

Figure 6. Figure 7.

For more information or courses in

your area, check out “Upcoming

Courses” off the NEWS & EVENTS

Menu at www.aurumgroup.com or

contact the Aurum Ceramic Dental

Laboratories Continuing Education

Department at 1-800-363-3989 or

email: [email protected].


CAST PARTIALS

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Troubleshooting CastPartials: Challenges andSolutionsGary Wakelam, RDT, CDT

CHALLENGE: Overall poor fit offramework.

SOLUTION: Use an impression tree toallow your cast to set up distortion free.After the impression has been poured,DO NOT invert the tray onto a stonepaddy. Inverting can cause error, as theunset stone will try to sag away from theimpression. The degree of sag (if itoccurs) will not be visible to the eye butis sufficient to cause poor fit of theframework. Instead, mound thick stoneon top of the tray and allow it to set.Before pouring the model, placePlaydoh (or children’s modelling clay)in the tongue area of the lower tray tokeep the stone from locking over the lingual flange.

CHALLENGE: Faulty, inaccuratecusp tips.

SOLUTION: If the tray is turned upsidedown onto the base of stone, there istendency for water to rise to the highestpoint (i.e., the cusp tips) on the model.The result is faulty, very soft cusp tipson the model and inaccuracy in the prosthesis.

CHALLENGE: Model has pitted orflaking appearance.

SOLUTION: There is saliva and/oralginic acid present. Separate the modelfrom the impression immediately afteradequate set (minimum 30 minutes;maximum 1 hour) and ensure thealginic acid in the alginate has been neu-tralized at the surface of the impression.Wash the impression (with a soap ofstone powder and water) using a camel’shair brush; thoroughly rinse the impression with clean running water;dry with compressed air and pourmodel immediately.

Twenty-first century materials andtechniques have made the creation of cast partial dentures

easier and more reliable than everbefore. Yet, the world of dentistryalways seems to be moving at “warpspeed”. The day-to-day demands, at alllevels, to produce more dentistry, morequickly often prevents us from steppingback and catching a problem when itactually occurs — versus having a particular prosthesis “fail” at insertion.

What happens during impression-taking, making a model, writing/readingthe prescription, or when placing theprosthesis are all possible critical factorsthat can dramatically impact on the qual-ity of the final prosthesis. If we can catchand reduce potential errors during theclinical and laboratory procedures, wecan save ourselves a lot of time andexpense.

The following is a summary of someof the common “challenges” I have beenasked about over the years. As you willsee from the “Solutions”, this list coversaspects of the process right from thestart through to final placement of theprosthesis and beyond.

CHALLENGE: Very tight fit ofclasps, will not allow frame to seat.

SOLUTION: Open clasp arm very slight-ly with pliers to allow frame to seat.

CHALLENGE: Soft, inferior stonesurface.

SOLUTION: Models that harden in 100%humidity have a superior stone surface.Wrap poured impression in a moist papertowel, hang on impression tree and allowit to set up.

CHALLENGE: Rests not seating orframe resting on teeth.

SOLUTION: Apply disclosing agent tointernal contact areas of frame. Insertinto mouth. Relieve premature contactsuntil seating is achieved. Polish adjustedarea.

CHALLENGE: Occlusal interferenceof rests or connectors.

SOLUTION: Identify premature contactswith articulation paper, paste or spray.Adjust metal with carbide burs and pol-ish. Leave minimum 1.5 mm thickness ofmetal. If necessary, adjust opposingtooth structure.

CHALLENGE: Addition of a tooth,clasp or section to an existing cast partial.

SOLUTION: In most cases, it is prefer-able to take the impression in the mouthwith the denture in place and remove itwith the impression.


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CHALLENGE: Finished cast partial isalmost, but not completely, seating.

SOLUTION: If adjustment of the prematurecontacts does not solve the problem, let thepatient wear cast partial for 48 hours. Aslight movement of teeth might have takenplace between appointments.

CHALLENGE: Patient has probleminserting or removing cast partial.

SOLUTION: Practice path of insertion ofcast partial on master model repeatedly.Demonstrate to patient in mouth. Let patienttry it until it is very easy to accomplish. Inrare cases, a notch in the acrylic will helpthe patient remove the cast partial with theirfingernail.

CHALLENGE: Clasps loose on abutment.

SOLUTION: Adjust clasp with Ortho pliers.Ensure adjustment only made to last 1/3(i.e., the tip) of the clasp. Gradually adjustthe clasp step-by-step until the retention isadequate.

CONCLUSIONAs you can see from this list, the old adagethat “an ounce of prevention is worth apound of cure” is very applicable withresolving many of the challenges presented.Sometimes it requires a basic change intechnique, sometimes it involves adding astep to avoid larger problems later on. In anyevent, a little care often pays off in bigimprovements in the final result with castpartials.


12

INNOVATIVE IMPLANT SOLUTIONS

“This 50-year old male patient was referred to our prac-tice, as he specifically wanted to resolve his dental issueswith an implant-based solution. As you can see from hisBefore photos, he presented with unrestorable, rampantdecay.

Restoration of this patient to dental health proceededover several years. The first step was an in-depth consulta-tion with the Oral Surgeon, Dr. Lewis Trusheim, as towhether we would utilize a fixed or fixed removable solution, how many implants would be placed and where,and how to best stage out the case. We decided to place atotal of 19 implants (10 in the upper arch and 9 in thelower) over time, allowing one area to heal and then loading those implants to assist with the restoration of thenext area.

We commenced treatment with extractions of all of the posterior teeth and placement of bone grafts and sinus liftswhere needed. A cat scan was then taken to allow us toplan out the case. First the upper and lower posteriorimplants were placed followed by the extraction of theupper anterior teeth and insertion of an immediate denture. After healing, the upper anterior implants wereplaced.

When the lower posterior implant had fully integrated,a lower implant impression was taken. On the day of the

lower anterior extractions, we were able to immediatelyplace the lower anterior implants and insert a temporaryfixed detachable prosthesis.

Once the upper anterior implants were uncovered, weinserted a temporary fixed bridge on temporary abutmentsreplacing the conventional denture. Final upper and lowerimplant impressions were taken along with occlusalrecords.

Upon reviewing the implant placements for the finalrestorations, we found the angulation of the implantswould have made the placement of the screw holes awk-ward. Based on that situation, we decided to proceed withEASI-ACCES™ upper and lower understructures with twosets of three porcelain-to-metal overstructures for eacharch. With the Easi-ACCES™ technique, the screw accessholes are placed on the lingual rather than the occlusal, ineffect hiding them from view. Just as important, these overstructures are now easily repaired in the event of aporcelain fracture (i.e., if there was a fracture in the anterior porcelain, that anterior section can now beunscrewed and sent to the laboratory for quick repair).Finally, the design of the Easi-ACCES™ frameworksresults in vastly improved access regarding hygiene.”

Dr. Robert Dores

Upper Arch Before. Lower Arch Before.

Full Face Before. Retracted Smile Before.



Dr. Robert Dores receivedhis Bachelor Degree inNeurobiology and Behaviorfrom Cornell Universityand then went on toreceive his Doctor of

Dental Medicine (DMD) at the

University Of Pennsylvania School OfDental Medicine, where he also servedhis General Practice residency. He haspracticed General Dentistry in NewMilford, CT since 1984.

Dr. Dores has completed severalcourses at the Las Vegas Institute for

Advanced Dental Studies (LVI) includingAdvanced Functional Aesthetics. He alsohas extensive experience in the treat-ment of TMJ and Myofascial Pain. Dr.Dores is a member of the AmericanDental Association and the AmericanAcademy of Dental Sleep Medicine.

Understructures – upper arch. Understructures – lower arch.

New Retracted Smile.

Overstructures in position – upper arch. Overstructures in position – lower arch.

Full Face After.

13


PRACTICE MANAGEMENT

Digital Dental Benchmarking:What do the numbers say?

Vijay Sikka, President and Chief Executive Officer, Sikka Software Corporation

Today you can apply powerful available technology (and some notso high technology tools and techniques) to help you uncoveropportunities and build profitability.This article will discuss how you canuse real time clinical and businessbenchmarking and Key PerformanceIndicators (KPIs) to reactivatepatients and reclaim your practice.

Profitability in Turbulent Economic Recovery:The Four “R” Factor

We are living with a shaky recovery in the United States.Depending on who you speak

with, you get different opinions, includ-ing some who say there is absolutely noimpact to dentistry. However, aftermeasuring over 7,000 installations indental practices, and understandingwhere the impact is, we know that thereare pockets of turbulence. This articlespeaks about those pockets and alsowhere there is opportunity andgrowth.

I have spoken at several meetings inboth USA and Canada based on ourexperience with the aforementionedmore than 7,000 installations. This paperwill attempt to share with you what youcan do to reclaim your peace of mindand profitability in this time of globaleconomic crisis. I refer to these as “The4-R (Reclaim) Factor”.

1. Reclaim ProfitabilityIf you have not optimized your fees, thisis the right time to align them with yourunique style and maximize profitability.How can you do that? Well, first get procedure revenue (adjusted), frequency,time units and current fees from yourpractice management system. Then fig-ure out your doctor production per hour,assistant salary per hour and chair timesplits along with lab and supply costs.Next, determine the rough cost fieldsfor each procedure code using thesecost numbers and subtract that from the

adjusted procedure revenue. Now youhave a profitability vector.

The next step is to get a zip codelevel comparison metric with other den-tists in your area. Remember, it is yourprofitability that has to be maximized —not your fees. So it is not about puttingyour fees to 95%ile or adding fixed dol-lars to your fees. It is about understand-ing how your fees are contributing toyour profitability. If you just take a rawgraph of how much production you havefor each procedure, you are looking atonly a partial picture.

2. Reclaim PatientsThe most important thing to considerwhen trying to reclaim patients is know-ing there is recare that is being missed.

Let me give you an example: Lets saythat you expect a patient who getsProphy to show up every 4 months forprophy appointments. Those who youdo Scaling root planing on should comeback every 6 months and they shouldcome in for Perio maintenance proce-dure. Now, imagine if you could havethis report or this list and ran it everymonth, you would completely addressthe problem of recare. You can do thisusing your practice management systemreports or with powerful new technolo-gy tools such as Practice Optimizer ®

that lets you do this with one click! Thisis just one example applying to Pedo prophy. There are literally hundreds ofother opportunities for reactivatingpatients in every practice.

3. Reclaim ControlThrough the use of technology, andeffective tools including your practicemanagement system or PracticeOptimizer® by SikkaSoft, start managingby numbers and get control back in yourhands. Effective control mechanisms aremorning meetings, profit and loss tracking, along with utilizing clinical andbusiness dashboards and benchmarks.

Vijay Sikka is the President and Chief ExecutiveOfficer of the 7 year old Sikka SoftwareCorporation. He is a healthcare informatics expertwith more than 20 years of software developmentand quality experience including large-scale projects with National Institutes of Health, GlaxoSmith Kline, Roche and UCSF affiliates. In 1996,Vijay founded IBrain Software, Inc., a businessintelligence company, and served as its CEO untilits acquisition in 1998 by Entigen Corporation,which later became part of Roche.

Editors Note: Sikka Software has a series of articlesavailable on a variety of practice management issuesincluding fee optimization, patient demographics analy-sis, and patient reactivations. For readers who would liketo receive these other articles, please email us at [email protected] and we would be pleased to sendthem to you.

Aurum Ceramic is committed to helping our clientsgrow thru Continuing Education and technology. The fullversion of this powerful and affordable software tool isavailable for purchase at a discount for Aurum Ceramicclients through Sikka Software.

You also should know how other dentists in your peer group are handlingtheir business and their clinical standardof care. What if you had all this informa-tion available to you in real time? Visitwww.sikkasoft.com to get free realtime benchmarking results.

4. Reclaim Zen Peace of mind is a function of the firstthree items in the list. So if you havereclaimed profitability, patients and control, you will have more revenue andan improved quality of life.

Current clinical and business bench-marking shows that hygiene and peri-odontal procedures are consistentlytrending below 2010 levels. However,both direct and indirect restorations (asa function of comprehensive exams) arealso trending upwards in the first quar-ter of 2011 compared to 2010. That isgreat news in this turbulent economy.

14


15

APPLIANCE THERAPY

Molar Uprighting

Rob W. Veis, DDS

In our last article (Part 1) of thisseries on Molar Uprighting, we dis-cussed the impact of abnormalities in

tooth position in general and withmesially inclined 2nd molars in particu-lar. In Part 2, we will cover the use ofeither a fixed or a removable orthodon-tic approach to effectively accomplishmolar uprighting. Both have their advan-tages and disadvantages.

Fixed AppliancesA variety of fixed appliances have beenproposed to upright tipped molars.Although the design and application mayvary slightly, the principals are the same.

Figure 1 shows an appliance sepa-rated into an active and stabilizing oranchor unit. To provide appropriateanchorage, all teeth as far forward as thecanine in the treatment quadrant shouldbe included. The canine on the contra-lateral side should also be linked to theanchor teeth by use of a heavy stabiliz-ing lingual arch. This canine-to-caninestabilizing arch not only increases theanterior anchorage but also resists buc-cal displacement of the anchor teeth.5

Although direct bonded brackets aresuitable for all the teeth, it may some-times be advisable to band the molar. Inthe simplest of cases where the premo-lars and cuspids are only being used foranchorage, the brackets can be placed inthe position of maximum conveniencewhere minimum wire bending will berequired to engage a passive archwire. Arigid stabilizing wire, .019 x .025 stain-less steel, is then placed in the premo-lars and the canine only.

The molar uprighting is done with ahelical uprighting auxiliary spring of.017 x .025 stainless steel wire placed inthe auxiliary tube of the molar. Themenial arm of the helical spring shouldbe adjusted to lie passively in thevestibule and upon activation shouldhook over the archwire in the stabilizingsegment. It is important that the hook bepositioned so that it is able to slide distal-ly as the molar uprights. A slight lingual

The Most Neglected Treatment in Dentistry(Part 2)

bend placed in the uprighting spring isneeded to counteract the forces that tendto tip the anchor teeth buccally and themolar lingually.6

Removable AppliancesThe uprighting of mesially inclinedmolars can often be accomplished with aremovable appliance. This applianceshould be designed to give you the bestretention and anchorage. This is accom-plished by having excellent tissue adap-tation, two to three clasps and a labialbow to prevent flaring of the anteriorteeth. This appliance usually incorpo-rates a spring or an expansion screw toaccomplish the desired tooth movement(Figure 2).

In cases where the molar is severelyinclined a fixed component can be added(Figure 3). Here an uprighting springinserts into a fixed molar bracket thathas a tube or slot. The spring then hooks

onto the removable appliance, which provides the necessary anchorage andprevents lingual tipping.

When using this fixed/removableapproach it is essential to place anocclusal rest on the distal aspect of theocclusal surface to prevent extrusion.2

While most general practitioners findremovable appliances easier to use,these appliances afford much less con-trol over tooth movement. The operatoris also completely dependent upon thepatient wearing the appliance full timefor treatment to be successful.

In our next article (Part 3), we willdiscuss molar uprighting appliance treat-ment procedures, adjustment tips, andappliance care.

President/CEO of the Appliance Therapy Groupand coauthor of The Principles of ApplianceTherapy for Adults and Children and TheTreatment of Snoring and Sleep Apnea for theGeneral Dentist, Rob W. Veis, DDS served as aClinical Associate Professor at the University ofSouthern California for more than a decade andcurrently lectures internationally on topics rangingfrom the application of appliance therapy dentaltechniques to dental economics and practicebuilding – while also maintaining a private practicein Los Angeles. He is a member of the ADA, theAcademy of General Dentistry, the Academy ofDental Sleep Medicine, the American Academy ofGnathologic Orthodontics, and Academy of SportsDentistry.

References:1. Pritchard, J: The Diagnosis and Treatment of Periodontal

Disease, Philadelphia, W.B. Saunders Co., 1979.Chapter 25, pp. 462-503.

2. Marks, Corn: Atlas of Adult Orthodontics, Philadelphia,Lea & Febiger, 1989. Chapter 18, pp. 391-412.

3. Moyers, R: Handbook of Orthodontics, Chicago,Yearbook Medical Publishers, 1980 Chapter 15, pp. 597-599.

4. Vanarsdall, Swartz: Adjunctive Orthodontics for theGeneral Practitioner Molar Uprighting, California, Ormco1987.

5. Profit, Wm: Contemporary Orthodontics, St. Louis, C.V.Mosby Co., 1986. Chapter 19, pp. 476-483.

6. Khouw, Norton: The Mechanism of Fixed MolarUprighting Appliances, J. Prosthetic Dent., April 1972,Vol 27, #4, pp. 381-389.

7. Brown, S: The Effect of Orthodontic Therapy on CertainTypes of Periodontal Defects, J. Periodontol., Dec 1973,Vol 44, #12, pp. 742-756.

Figure 1 - Fixed Appliance.

Figure 2 -RemovableAppliance withclasps and a labial bow.

Figure 3 -RemovableAppliance withadded fixedcomponent.


16

PICTORIAL PROFILE

“This 22 year-old female patient wasreferred to me last year by the ExecutiveDirector of Casa de Amparo, a non-profitorganization that provides care to children and teenagers that have beenremoved from their homes due to abuse orneglect. She was in a program called NewDirections, where young adults are givenassistance in transitioning from foster careinto the adult world. Participants betweenthe ages of 18-24 may stay for up to twoyears and are required to be employed,looking for work, or in school. The patientwas working, living in an apartment subsidized by the program, learning todrive, and becoming financially independ-

Close-up of pre-operative smile. Close-up of new smile.

Retracted pre-operative smile. Retracted restored smile.

ent. At the time of her initial visit, shewas in an acute pain situation, and I wasasked if I could help her.

I scheduled her for a comprehensiveexamination and hygiene appointment soI could assess the extent of her problems.Upon exam and x-rays, I found she haddeep decay in three teeth that wouldrequire root canal treatment. In additionthere was decay present in sixteen otherteeth. Her periodontal condition was fairwith pockets ranging from 2 to 4 mm withlocalized bleeding especially around theexisting stainless steel crowns on #19 and30. At age 22, she had already had fiveroot canals.

My first priority was getting her out ofpain. I placed temporary crowns on teeth#2, 29 and 31 after gross caries removaland buildups so the endodontist couldclamp the teeth. A colleague that I referto in my community, Dr. Craig Malin,kindly agreed to perform the root canalsat no charge for the patient. After paincontrol was completed, I made a treat-ment plan by quadrants to restore herother teeth. As I began the treatment Idecided to also replace the stainless steelcrowns and aging silver-mercury fillings,as the overhangs and poor contourswould jeopardize periodontal health. Icontacted Ulf Broda at Aurum Ceramic


17

Pre-operative upper arch. Restored upper arch.

Pre-operative lower arch. Restored lower arch.

whom I had worked with since my FullMouth course at LVI in 2002 and askedif they would consider helping me withthe lab fees for her crowns. AurumCeramic agreed to fabricate E.max HTcrowns for my patient as needed.

Last year my schedule had not been asbusy due to the changing economy, andsince I had openings, it allowed me thetime to provide her pro bono care. Earlyin my LVI journey, Bill Dickerson gave alecture where he commented that our pro-fessional courtesies shouldn’t just bereserved for other health care profession-als who can afford the best care, butinstead for other members of our

communities who really need the help.This was an opportunity to give back tomy community by helping this youngwoman with her extensive dental needs.My treatment included nine IPS e.maxHT crowns on #2, 8, 9, 15, 18, 19, 29, 30and 31; and fifteen multiple-surface com-posite fillings using 3M Filtek SupremeUltra on teeth #3, 4, 5, 7, 10, 11, 12, 13,14, 20, 22, 25, 26, 27, and 28. Dr. Malincompleted endodontic treatment on #2, 9,29 and 31.

Although this case was neither a full-mouth neuromuscular rehabilitation nora complete smile makeover, it certainlygave me a great feeling to help Marissa

with her dental needs. She is a veryquiet, shy woman and rarely spokeabout her personal life, but by the end ofher treatment she was learning how tosmile again. Last fall at a reception forCasa de Amparo donors the director recognized me for my contribution toMarissa. I did not write a check for$25,000 to the organization as some ofthe other patrons had done, but I didprovide what I do best — quality comprehensive dentistry — to a deserving young woman in need.”

Mary A. Walsh-Cole, DMD


Mary A. Walsh-Cole,DMD graduated in1980 from TuftsUniversity School ofDental Medicine in

Boston, MA. She completeda General Practice Residency at USC/Los Angeles County Medical Center andhas been in private practice in Encinitas,CA since 1984. Her practice focus is inaesthetic restorative and neuromuscular

dentistry. Since 2001, she has takenextensive training at the Las VegasInstitute for Advanced Dental Studies(LVI) completing sixteen courses. Shehas recently returned with her team toaudit the new Core Curriculum.

Dr. Walsh-Cole received herFellowship from the Academy ofGeneral Dentistry in 1995 and herMastership in 2005. She is a memberof the American Dental Association,

California Dental Association, SanDiego County Dental Society,International Association ofComprehensive Aesthetics, Academyof Comprehensive Esthetics andDOCS. She was a member of the3M/Espe Council for InnovativeDentistry from 1999 to 2005 whereshe evaluated new concepts and products in the development stage.


18

Close-up of e.max centrals #8-9.

Full face After.

Pre-operative lower left quadrant with PFM on #18, stainless steel crownon #19 and amalgam in #20.

Restored lower left quadrant with beautiful e.max crowns on #18-19 andcomposite restoration on #20.


19

CONSULTANTS CORNER

Sherry Blair, CDA

category is the one that costs us somuch productive time. We tend todwell on it, rehashing the criticismover and over again among ourselves.Human nature keeps us focused onthat one angry patient instead of thehundreds of happy ones.

Dealing with “Needy” PeopleOur needy people might appear in ourpractice as the “incurably insecure”patient, “drama kings or queens”, and/or“blabbers”. The best approach with thesetypes of difficult people is to:1. Focus on the solutions and not the

problem. Have them focus on details:“Who exactly”, “Where exactly”, “Whatexactly”, and by all means avoid “why”.

2. Be very clear with your guidelinesaround your expectations.

Dealing with the “Manipulators”These people seem to be very indirect.We sometimes call them our “sub-groupers” who like to focus on gossipand rumors. How do you approach thesepeople?1. Recognize the control. Be aware of the

fact that you are always having a hardtime saying “no” to them.

2. Define the relationship. Let them knowthat you are not willing to listen to anyinformation about someone who is notpresent. Use statements like “Haveyou told them what you are tellingme?” “Can we all discuss this together?” If the answer is “no”, letthem know that if they change theirmind you will be willing to arrange atime that it can be discussed witheveryone involved and walk away.

More importantly, we always want to befocused on prevention. Mastering thebest relationships through great commu-nication can be your best prevention.This takes time. In our busy practice, weoverlook the importance of slowing downand taking the necessary time for propercommunication. For our patients, thatwould mean making sure we have theproper patient care systems: New patientexperience, existing patient

Dealing withDifficult People

experience, financial presentation, andproper scheduling so that we are neverrunning behind. For your team andDoctor communication, make sure thatyou are having productive team meet-ings, with open communication in addition to regular performancereviews, for truly effective feedback. Ofcourse, above all, ensure you haveinstilled consistency and continuitythroughout the team. This will lead toultimate results in any practice.

As Director of the Dynamic Team Program at theLas Vegas Institute, Sherry Blair shares her morethan 37 years of experience managing each andevery system within the dental practice. Sherryhas combined her acquired knowledge and per-sonal experience to create an inspired, effectiveand motivated curriculum that refines the systemssurrounding the patient’s total experience in adental practice. Sherry’s extensive exposure tomost forms of practice management and dentalsystems, as well as her strong focus on patientsatisfaction, make her uniquely qualified toenhance the effects of any dental practice.

We all have them in our practices- whether it is the patients,team members, or the Doctor.

They zap our energy and cost us produc-tive time. We even take them home withus, buckle them in with the seat belt sowe don’t lose them on the way home, andangrily share them with our family whenthey ask, “How was your day”. “Well, letme tell you how my day was . . .”

So how do we deal effectively with theday-to-day stresses of our lives? First ofall, be careful not to confuse difficult people with difficult situations. Difficultsituations might arise with the patientwho has to swallow every two seconds,or that patient who can’t lay back - thereis a difference between a difficult personand a difficult situation. Difficult peoplecan usually be put into three categories:critical, needy or manipulators.

Dealing with “Critical” PeopleRight off the top, we all have to under-stand that we will be criticized at somepoint in our lives. With critical people, wehave to evaluate the criticism and reactbased on our evaluation. You basicallyhave three categories of criticism, whichwould require three different reactions: 1. Constructive criticism – Where the

criticism is meant to help, not hurtand when the criticizer is

knowledgeable - thenyou should choose to

listen.2. Answer thecriticism - Where

the criticizer doesnot have all the

information orfacts and is open

minded, then weshould choose to give missing information.

3. Dismiss the criticism- if the criticism isactually just ridicule

(patient is angry becauseyou aren’t open on Sundaymornings...), we shouldchoose to let it go!Unfortunately this latter

For more information or courses in

your area, check out “Upcoming

Courses” off the NEWS & EVENTS

Menu at www.aurumgroup.com or

contact the Aurum Ceramic Dental

Laboratories Continuing Education

Department at 1-800-363-3989 or

email: [email protected].



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77002 AurContNL Spok Vol15-2:G399€¦ · 2 CONTENTS In the News Advanced Esthetics —Precision and Esthetics with IPS e.max® CAD and Core 3d Centers™ Dr. John Krasowski Grant