Volume 19, Issue 1

The “Business View” on Digital Dentistry Innovative Implant SolutionsAbutments on Implants – In Four Easy Steps

Pictorial ProfileJust as Beautiful - Ten Years Later!

Consultants Corner The Art of “Screw-mentation”Eliminating Cement Issues in Implant Restorations

Orthodontics The Economics of Sleep

Visit us at www.aurumgroup.comComplete Root-to-Tooth™ SolutionsThe Aurum Group® – All Under One Roof

continuum™

The Aurum Group® - Specializing in Comprehensive Aesthetic & Implant Dentistry

The series includes:Webinar 3“The “Pre-Approved Smile” Preparation Technique”Predictable, Conservative Preparation Based on the Patient-Approved Wax-up

Webinar 4“Placing and Finishing Minimum-Prep Veneers” Creating an Outstanding Final Result – Placement and cementation tips

Purchase the Series in total for $349 or choose individual Webinar titles at $99.00 per Webinar.Available On-Demand – view the Webinar(s) when you want to view them.

Both options include an on-going email Q&A component with Dr. Larose!

For more information on this and other CE opportunities, please check out the “Upcoming Courses” link off the EDUCATION Menu on our website at www.aurumgroup.com OR contact Aurum Ceramic Dental Laboratories Continuing Education Department at 1-800-363-3989 (email: ce@aurumgroup.com)

Aurum Ceramic designates this activity for 1 hour per webinar of continuing education credits.

Webinar 1“Getting Ready for Success with Minimal-Prep Veneers”Easy to apply systems for clinical assessment and smile evaluation!

Webinar 2“The Aesthetic Consultation and Wax-up Appointment”Working with the patient for the optimal end result!

Ultra Conservative Minimal-Prep VeneersFeaturing Dr. Danièle Larose

A step-by-step guide featuring an actual clinical case and live patient, in four on-demand webinars

• Proven, effective and aesthetic solutions to common anterior dental challenges. • Appeal to today’s well-informed patient by adding minimum-prep techniques to your aesthetic anterior case armamentarium.• Series covers everything you need to know to start and finish your first minimum prep case.• Also packed with invaluable tips for those already placing minimum prep veneers. • Combination of in-depth discussion and practical live illustrations of each aspect.• Delivers a true “over the shoulder” experience for the clinician.

Announcing: A NEW Webinar Series

In the News: Contents

3Shape’s Rune Fisker to Speak at “The Dental Technology and Business Growth Summit 2015”

Digital DentistryThe “Business View” on Digital DentistryDr. Jonathan Ferencz

Innovative Implant SolutionsAbutments on Implants – In Four Easy StepsDaniel Kohm

Pictorial ProfileJust as Beautiful - Ten Years Later! Dr. Michel Poirier

Cast PartialsTroubleshooting Flexible Partials: Challenges and SolutionsGary Wakelam

Implantology The Art of “Screw-mentation” Dr. Bobby Birdi

Technique TipPhotography 101 - Great Photos tell a thousand words!Ulf Broda

OrthodonticsThe Economics of SleepErin E. Elliott

Consultants CornerTouch Points - Bring Your Patients’ Experience to Life Sherry Blair

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The Aurum Group® is pleased to announce that Rune Fisker, VP Product Strategy and Business Unit Director, Dental Lab and Dental Clinic at 3Shape will be speaking at the upcoming Dental Technology and Business Growth Summit 2015. A key creator and driver of 3Shape’s solution-orientated innovations, Mr. Fisker fills his presentations with concrete CAD/CAM technology methods and his vision of the future “Digital Dentistry”. He has been with 3Shape since the beginning and holds a Ph.D. from Denmark’s Technical University and an executive MBA from Copenhagen Business School.

Gather with dental professionals from across North America from October 1-3, 2015 in beautiful Banff, Alberta. The Aurum Group® has brought together a diverse group of premiere opinion leaders on applied dental technology and the art and discipline of entrepreneurism including Chris Hadfield (Astronaut and First Canadian Commander of the International Space Station) and Arlene Dickinson (CEO of Venture Communications and YOUINC.COM and “Dragon” on TV’s Dragons’ Den) as Keynote Speakers. Go to our Special Event website at www.aurumgroupsummit.com for full details.

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Rune Fisker, Ph.D., MBA. u

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Aurum Ceramic® Dental Laboratories LLP E-mail: aurumspokane@aurumgroup.com

Spokane 1320 N. Howard, Spokane, WA 99201-2412 (509) 326-5885 Toll Free 1-800-423-6509

Visit our Website at: www.aurumgroup.com

Except where specifically stated otherwise, views expressed in this newsletter are the opinions of the individual contributors and do not reflect the views of the Aurum Group®. The information contained herein is not intended to be comprehensive and readers are advised to rely exclusively upon their own skill and judgement and to inquire further before acting on the information. The Aurum Group® assumes no responsibility for any errors or omissions found herein nor for any loss or damage caused by any errors or omissions, whether such errors or omissions are the result of negligence or any other cause. Offers contained in this newsletter are not valid where prohibitedby provincial regulation.

© Aurum Ceramic Dental Laboratories LLP (2015) All Rights Reserved.

Continuum™ is published by Aurum Ceramic Dental Laboratories LLP on behalf of the Aurum Group® of Companies

Check out “Upcoming Courses”off the NEWS & EVENTS Menu at www.aurumgroup.comfor details on all of the upcoming programs and events in your areas.

Certification Number: AJAEU/09/13949

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Q. Why is digital dentistry such a topical item in the industry today? What do you see happening?

A. The subject of Digital Dentistry can be overwhelming and confusing to the average dentist, yet I hear it more and more in quiet conversations at lectures, tradeshows and dental gatherings. I believe we as dentists see the exciting new technologies but don’t know how to jump in, where they fit in OUR practice, or how to take advantage. We see it but we are afraid to change our business model.

Digital dentistry and CAD/CAM creation of dental restorations can be viewed as a disruptive change by clinicians and technicians alike. This is no different than it was several decades ago in other industries. Digital photography changed the landscape in how both professionals and the general public “snapped and developed” their photos. Digital publishing changed how we create and consume information. As these industries underwent “digitization”, a number of high profile participants dug in their heels and proclaimed “we won’t change”. Consider Eastman Kodak’s well-publicized attitude: We’re a film company today and we’ll be a film company tomorrow. Don’t worry, this will all blow over. I think we all know how that worked out. I just heard a story about the former editor of the New York Times, who was asked as he joined a digital publishing company himself, “What will happen to the publishing industry with this move to digital publishing, and what will happen to all those analog people who refuse to adapt?” His answer was short and succinct: “Some traditional publishers will be able to make the transition but many will disappear only to be replaced by new digital players with ideas and business models we have not yet thought of !”

There are many questions that every participant in the dental industry has about the move to digital dentistry, no matter what level of adaptation or knowledge they may have currently attained. Our objective in this article is to pose some of the most frequently heard questions and to provide some answers via a quick Q&A overview with Dr. Jonathan Ferencz.

I think the second part of this equation is the slowdown in demand for dental services that many traditional practices are still feeling today. I believe that dentists struggle with what to do when our business slows down. We lack the business acumen to look at new technology as a business builder - a way to create new income streams for our practices or to make what we are doing more efficient and profitable. Let me give you a personal example. During the economic shock of 2008, I identified four other practices similar to mine (multiple dentists, in-house lab, etc.) in New York City and asked them to join me in the “New York Prosthodontic Roundtable”. We would meet regularly to share best practices and ideas. I was shocked when it came time to discuss ideas on what to do during this slowdown. These large, successful practices were “turning off lights in unused areas”, laying off staff, negotiating with their suppliers. They were equally shocked when I told them my strategy was to take advantage of the slowdown to retrain myself and my staff in the newest techniques, to invest in the latest technologies, and to be ready to hit the ground running when the New York dental market turned around – which of course it did.

Q. What was your pathway in incorporating digital dentistry?

A. I was first introduced to the concept of scanning in the 1970’s but I wasn’t ready to adopt it at that time. In 2000, I worked withNoble Biocare, at the time the #1 dental implant system in the world, which had just introduced Procera, the first CAD/CAM system for high-end prosthetics. I worked on many interesting projects, including educational events regarding model scanning and production of custom abutments. Over time, we added implant-supported fixed bridges and CAD crowns to our repertoire.

Most of these options were successful but we had trouble, as did everyone else, with veneered Zirconia restorations (i.e., chipping of the veneer surfaces). The reason: our lack of understanding as a profession regarding the properties of Zirconia itself. This was resolved in our practice as the industry moved to Lithium Disilicates and monolithic Zirconia restorations.

The “Business View” on Digital Dentistry A Q&A Session with Dr. Jonathan Ferencz, Diplomate American Board of Prosthodontics

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For me, a huge step up occurred when we moved to the 3Shape Model Scanner. As an optical scanner, as opposed to our former contact scanner, with far better design software, this Scanner opened up new doors for our digital practice. After that, I worked with Henry Schein and was exposed to the E4D system, bringing intra-oral scanning and milling into our practice. We continue to evolve in how we do things. Most recently, I have added the color Trios Scanner. I worked tirelessly to open our in-house workflow to allow designs from this new Scanner/Design package to flow to our E4D mill, where we have done over a 1000 units to date. Today, we are also sending some designs to Core3dcentres to mill while we continue to mill others in-house – it all depends on the indication.

Q. How has this impacted your restorative practice?

A. Let me answer this by talking about the progression of the “gold standard” in dentistry over the years. With PFMs, the gold standard was the high gold content crown covered with layers of beautiful, expertly applied porcelain. Today, the handmade crown is still the perceived gold standard that digital results are compared to in the dentist’s mind. For some reason, dentists still believe that “handmade” is better, but is it really? In my practice, if I compared any 10 CAD/CAM crowns to 10 handmade crowns, I might have 1 or 2 handmade that fit slightly better or look a bit better compared to their digital counterparts, I’d have four that are basically the same and 4 or 5 where the CAD/CAM crowns are noticeably better. The key point is that the consistency of results I get with CAD/CAM is amazing. It eliminates the technique variables and the human factor that can compromise even the best case.

Q. What about implants and implant-based restorations?

A. I was anxious myself about starting digital dentistry with implants. There was always a big learning curve with CAD/CAM – 100 units, maybe 200 before you feel you have it down. I started my digital journey with simple posterior crowns. Once comfortable

with that, I moved on to treating posterior quadrants, then anteriors, then bridges, all of this before I even considered an implant case. Even then, I was pushed into it. One of our older patients had significant bone and soft-tissue attachment loss and eventually had lost a tooth. She did NOT want standard impressions. In her opinion, that would “just loosen the next tooth to go”. I mentioned we could take digital impressions for her implant case, but I had never done it with implants and wasn’t sure about the result. She said she trusted me and to give it a try.

The first thing I noticed when I received the crown back was that the contacts were 100% on the money (this rarely happens with handmades). Now I am doing implant-based posteriors, bridges and anteriors digitally (I am still not comfortable with full arch cases, I tend to do them in sections) and I notice that the contacts are 100% all the time. So that’s the first impact: the Absolute Accuracy of the Contacts with digital.

The second thing I had always noticed with handmade bridges on implants, the patients always winced when I tightened the screws. There was always a pressure there due to slight inaccuracies in the handmade process. It usually goes away quickly but it was there. Now, with digital scanning and CAD/CAM milling, this has completely disappeared. The second impact: Absolute Passivity of Fit.

Q. Will this be embraced by every dentist and technician? What are the hurdles you hear from dentists and technicians they feel are preventing them from embracing digital dentistry?

The top hurdle is always the same: it’s too expensive. Then the arguments are based on either a perceived lack of quality (I’m told they don’t fit as well, I take excellent impressions, high-end labs and practitioners don’t do it – they still take impressions and layer porcelain) or resistance to change (I’m too old, I already know how to do handmade). Not everyone will change.

A friend of mine, a retired dental school dean, recently asked me “Why is it the average

dentist does not even think twice about buying a $60,000 Mercedes but “can’t afford to invest in Digital Dentistry”? Part of the problem is in understanding the value each offers. We understand the value of that Mercedes in terms of our driving experience, pride of ownership, etc. Yet, we struggle with quantifying the value of that scanner or milling machine or digital radiography. Strangely enough, for many dentists, the Mercedes is an “investment”, the Digital equipment an “expense”. We struggle with running a business, and we often don’t see a trend until it runs over us.

It is those very trends that we have to be aware of. The rising tide of Dental Service Organizations is here to stay. They are smart business guys and they have invested heavily in CAD/CAM. They see the value. In Chicago, I heard one place a single order for 100 scanners. In this environment, the traditional dental practice and lab will both have trouble unless they adapting digital technology. Many of them will ride it out to retirement or just disappear.

Q. Some technicians are telling their clinicians “it’s not ready yet, it’s not accurate enough, don’t invest yet – something better is just around the corner”, yet they themselves are investing heavily in their own laboratories. Should dentists be waiting for the next best thing?

A. First, let me clarify one thing. I have had an in-house lab for over 20 years. I have never had to deal with a lab that says “digital isn’t ready” or “it doesn’t work”. My current technicians have always worked with digital.

That being said I do not subscribe to the “don’t buy today, it’ll be obsolete tomorrow” way of thinking. I think the key with technology is to look for the supplier that provides a pathway for change and upgrade. Apple is a great example. I bought my first MAC in the ‘70’s. As a long-time Apple user, I realized pretty quickly that their hardware doesn’t become obsolete; they continually update the software to give extended and improved use. Some of the Apple equipment we have in-office today is over a decade old,

Dr. Jonathan FerenczDr. Jonathan Ferencz graduated from Rensselaer Polytechnic Institute in 1967 and New York University College of Dentistry in 1971. He joined the faculty at NYU as a part-time instructor in pre-clinical and later, clinical fixed prosthodontics and opened a private practice in midtown Manhattan in 1972. In 1980 Dr. Ferencz enrolled in the part-time Post-Graduate Program in Prosthodontics and, upon completion, in 1984, established the first Honors Programs in Prosthodontics for fourth year students at NYU. This program was responsible for the recruitment and training of many individuals who

went on to become prominent prosthodontists. In 1990, Dr. Ferencz became Clinical Professor of Post-Graduate Prosthodontics and was certified by the American Board of Prosthodontics in 1998. In 2014 he was named Adjunct Professor of Restorative Dentistry at the University of Pennsylvania School of Dental Medicine.

In addition to private practice and part-time teaching at NYU and Penn, Dr. Ferencz has been very active in continuing dental education, having given more than 250 courses and programs throughout North America, South America, Europe and Asia.

In the past few years he has become increasingly involved in clinical research at the Bluestone Center for Clinical Research at NYU. His areas of research have included high strength ceramics CAD/CAM and complete dentures. He has nearly 30 publications in the dental literature and has been a reviewer for two prosthodontic journals. His textbook, “High-Strength Ceramics: Interdisciplinary Perspectives” co-edited by Nelson Silva and Jose Navarro was published by Quintessence Publishing Co. in 2014.

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and still humming along. Look for providers of Scanners, CAD/CAM, etc. with a track record of providing regular software updates that truly improve performance.

Temper that with a different mindset in your practice. Equipment doesn’t just have to last ten years as a rule, the key is does it pay for itself every day? When something faster, smaller, more efficient, or producing higher quality comes along, make the decision to change it based on productivity or ROI. Can you make more money or have an easier time with that new unit? That’s the question.

There’s an intangible R.O.I. to an investment in digital dentistry that also needs to be considered. Ask yourself a few simple questions. Will this lead to better quality dentistry? Are there real benefits to the patient? Will this result in fewer remakes? Will more patients accept treatment and refer new patients?

Q. Where is digital dentistry appropriate? Where do you feel it isn’t appropriate?

A. As digital dentistry matures, there are fewer and fewer clinical situations where it can’t be used. There is a personal comfort level aspect to all this as I outlined earlier. For me, there are still those full arch implant cases I don’t quite feel comfortable with yet. Plus, with many workflows today, we still go in and out of digital as we proceed through the case.

In my own practice, I now complete many cases based on a diagnostic scan only, I no longer do diagnostic impressions or a diagnostic wax-up on those cases at all. It is all done digitally!

Q. We’ve heard about “open architecture” versus closed systems. What does it all mean, how important is it, and where is it going?

A. Let’s return to our analogy of digital photography. Do you remember the first digital cameras? They had their own memory stick that only fit that brand of camera, would

The subject of Digital Dentistry can be overwhelming and confusing to the average dentist, yet I hear it more and more in quiet conversations at lectures, tradeshows and dental gatherings.

only work with their brand of computer and only print images on their printer. That was a “closed system”. That certainly doesn’t apply in the digital camera arena today. The user base drove the companies to accept generic cards and industry standards to facilitate working with any computer or printer. That is an “open system”.

In dentistry, E4D and Cerec are historical examples of closed systems. Their files worked with their systems only. You scanned, designed and milled on their systems. There are other examples where the raw materials are designed to only work on certain milling systems, etc. This too will change over time. The dental user is already demanding a more open approach. Certain manufacturers only make mills and/or scanners so they support an open architecture that lets their equipment work with other parts of the workflow. There are generic raw material manufacturers pushing for simple, more universal approaches. This will grow as the market matures. At the end of the day, open architecture will win in dentistry as it has in cameras, computers and many more digital industries.

Q. Who benefits from this – and what are the limitations? What still needs to be developed?

A. Typically it is the specialist manufacturers who will benefit, those offering the best printers, the best materials, the best systems. Of course, at the end of the day the dentist and patient truly benefit as this evolves. In terms of limitations, two spring to mind right now:

• We need the ability to switch from subtractive manufacturing (i.e., milling restorations) to additive manufacturing as we just started to do with resins, PMMA’s, etc. This would be a tremendous boon to the industry in the area of ceramics, for example.

• We need intraoral scanners that can see the margin through the gingiva, saliva and blood. The benefits are obvious.

Q. What challenges and opportunities are there for the lab industry?

As with the dental practice, the dental lab will have to re-invent itself. They will have to come up with new and innovative ways of supporting the dentist on-site at the practice – and through them, better support of the patient (same day crowns, in-office scanning of abutments by technicians, in-office finishing of crowns, bridges and appliances).

As we move forward, I see this going much further. Milling centers are looking more like labs and labs are looking more like milling centers – both adding value for the practice and patient to what they already provide. I also see the day where dental practices will join in. I see an eventual coalition of practice, lab and milling center into one entity.

Look at my own practice. We have 3-4 dentists at any given time, three scanners, one mill (with another on the way), an in-house lab with 3 technicians – all going full blast every day. Much like the model I predict for the future but we too will have to adapt.

Plan to Attend

“The transition from analog to CAD/CAM dentistry: Steps to achieve success”with Dr. Jonathan Ferencz

• Dental Technology and Business Growth Summit Banff AB October 1–3, 2015

For more information or courses in your area, check out “Upcoming Courses” off the NEWS & EVENTS Menu at www.aurumgroup.comor contact the Aurum Ceramic Dental Laboratories Continuing Education Department at 1-800-363-3989 or email: ce@aurumgroup.com.

Dates subject to change. Please call to confirm course dates.

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Abutments on Implants – In Four Easy StepsDaniel Kohm, CDT

Implants continue to be the restoration choice for restoring partially or totally edentulous patients. To meet this growing demand, it is important to become strategic and systematic in approach, covering each step from implant placement to final restoration. A successful restoration must be sound in principle and in practice, and perhaps most importantly, it must withstand the test of time. Aurum Ceramic’s exclusive Easi-ACCES® restorative technique fulfills all of these criteria and provides many advantages at all stages of the restorative process, from surgeon to dentist right through to the hygienist and long-term patient care. Best of all in today’s dental practice, aesthetics and function are easily harmonized by utilizing this type of restorative approach.

In this article, we will illustrate some of these benefits via an actual case study, reviewing the steps to be taken after implant placement and integration has taken place. The Easi-ACCES® technique was chosen for the four anterior abutments for this particular case in consultation with the restorative dentist (Dr. Brian Schow, Calgary AB), as otherwise the abutment screws would be coming through the labial. The posterior sections were conventionally screw-retained through the occlusal surface and attached to the anterior section with locking attachments. (Fig. 3) The lower was completed in the same manner. (Fig. 4)

1. Create “Impression Jig” from initial impression

After the clinician has taken the initial fixture level impression and a model poured, the laboratory will remove the impression copings, place them on the model, splint them together with self-curing acrylic and then separate. The laboratory will make a custom tray with the impression copings clearly visible on the top of the tray (Fig. 1).

2. Utilize “Impression Jig” to take Final Impression

The restorative dentist places these laboratory-fabricated impression jig components, joining it together intra-orally with a self-curing acrylic or light cure composite and takes the final impression. When this type of impression jig is employed, fit rarely becomes an issue.

3. Fabricate the Abutments

After a full wax-up is created by the laboratory, the abutments are fabricated and milled at a 6 degree taper. Lingual holes are drilled and tapped to receive transverse screws. (Fig. 2) With this technique, we use Straumann Abutment screws, as they have a coarse thread and transfer easily into the oral cavity.

4. Abutment Try in

The laboratory then reconstructs the full wax-up. This wax-up is used to try in the newly fabricated abutments and a new bite is taken.

In summary, here are the four steps again:

1. Create “Impression Jig” from initial impression

2. Utilize “Impression Jig” to take Final Impression

3. Fabricate the Abutments

4. Try in new Abutments and take new bite

The case is now ready to go to final stages of restoration fabrication.

p Figure 2

p Figure 3

p Figure 4

q Figure 1

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When we initially place any extensive case, we all may consider how this case is going to “withstand the test of time”? In our practice, we have had a unique opportunity to actually track a Full Mouth case over almost 10 years. This female patient is actually the hygienist in our office. Approximately 10 years ago, she was very unhappy with the condition of her smile, feeling that her teeth just weren’t up to her own high standards. As you can see in the Before photos, her occlusion had collapsed 100%, she had large restorations throughout her mouth (both amalgam and composite) and she was missing #14. In addition, she was experiencing issues with her general oral health. She had been treated for her deep overbite previously, but she was still experiencing a click in her TMJ and had definite muscular problems as she could only open her mouth 25 mm. This Trismus condition can have serious health implications, including reduced nutrition due to impaired mastication, difficulty in speaking, and compromised oral hygiene. She a very clear goal in mind stating, “I don’t like my smile at all. I want a healthy smile”!

Being a key member of the practice, she was completely familiar with the possibilities offered by neuromuscular treatment and Full Mouth rehabilitation. The first step in the process was to utilize K-7 diagnostic software and a TENS unit to determine her comfortable bite position. After placing an implant in #14, we then used a Removable Orthotic for one year and then a Lower Fixed Orthotic (fabricated from a Myobite) for a further three months to bring the mandible in its Neuromuscular position. At that point, we checked the patient’s revised bite on the K7. Both the patient and I were satisfied with the new bite, everything was in alignment, the symptoms had disappeared and she was comfortable.

For Phase two, we took a transfer bite, and chose a Smile Design, tooth shape and shade. An upper and lower Diagnostic Wax-up (built to the new vertical dimension and bite) was prepared by Aurum Ceramic AE (Advanced Esthetic) Team™ showing the patient her new smile, which she eagerly accepted. We prepped both the upper and lower arches in one visit, using Prep Indices, and Bite Stent from Aurum Ceramic as per their ACCES System and placed temporaries created from a Siltec Provisional Stent also supplied.

The temporaries were in place for one month. Being in the office through that time, it was easy to discuss and make adjustments to the temps for shape and length, etc. as required. After that trial period, we restored both upper and lower arches with IPS Empress crowns and a zirconia crown on a Titanium abutment on the implant placed earlier on #14. The Titanium abutment was perfectly opaqued by Aurum Ceramic’s AE (Advanced Esthetic) Team™ to mask any metal. These skilled technicians also created the beautiful final IPS Empress restorations, superbly characterized to create a truly natural final smile that perfectly matched the patient’s facial features and personality. We tried the restorations in, everything was excellent in terms of fit, shape and colour, our patient was ecstatic and we completed final cementation.

The patient has now had her restored smile for almost ten years. The annoying “click” she had been experiencing completely disappeared with the placement of the final restoration. She can now open her mouth normally. He continues to say how he has the “100% smile” he was searching for, beautifully white and beautifully natural.

Restorations fabricated by Aurum Ceramic

p Full face Before.

Just as Beautiful - Ten Years Later! Dr. Michel Poirier

p Close-up of pre-operative smile

Dr. Michel PoirierMichel Poirier, D.D.S. graduated from Université de Montréal School of Dentistry in 1977. He is in private practice in St-Jérôme, QC, where he focuses on advanced aesthetic and neuromuscular dentistry.

Dr. Poirier has always has a strong commitment to Continuing Education. In 1993, he completed a level 5 rehabilitation certification at the prestigious Pankey Institute and then completed an implantology fellowship at Misch International Implant Institute in 1995. In 2002,

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Dr. Poirier received first prize for his presentation on progressive bone loading during the International Congress of Oral Implantologists held in Montreal. He has been a Diplomat in Implantology since 2007. Dr. Poirier has also received specialized training on bone grafting from Dr. Vassos of Edmonton, Alberta and Dr. Par Allen and Carl Misch in the USA.

Dr. Poirier is a graduate from the Las Vegas Institute (LVI) in neuromuscular and aesthetic dentistry. In addition, he is the founder and

a key speaker at l’Académie St-Pierre (post-graduate training for dentists on general and neuromuscular dentistry) and has served as a lecturer at McGill University for oral surgeons and prosthodontists.

Dr. Poirier is a member of International Congress of Oral Implantologists (ICOI) as well as the Ordre des Dentistes du Québec (ODQ).

p Pre-operative smile – Right p Pre-operative smile – Left. p Retracted pre-operative in Centric Occlusion.

p Fixed orthotic at the new VDO. p Taking the transfer bite. p Diagnostic Wax-up.

p Retracted restored smile. p Retracted restored smile – teeth apart.

p Full face After.p Close-up of new smile. p Close-up of new smile today!

Dental Technology and Business Growth SummitOctober 1–3, 2015in Banff AB You don’t want to miss this, there is nothing like it!

Mr. Chris Hadfield “The Sky is not the Limit”

Ms. Arlene Dickinson“Lesson’s from the Den:

Succeeding at Business & Being an Entrepreneur”

For more information or to register, please call 1-800-363-3989

or email ce@aurumgroup.com or visit www.aurumgroupsummit.com

When: October 1 – 3, 2015

Where: The Banff Centre 107 Tunnel Mountain Dr, Banff, AB T1L 1H5

Room rates: The Banff Centre Starting at $170 per night, plus applicable fees & taxes

Call 1-800-884-7574 to reserve your room and quote “TAG1510” for the special rate.

Registration Fees*: Aurum Group® Platinum** Clients: $1595.00Aurum Group® Clients: $1795.00Non-Client Dentist/Technicians/Lab Owners: $1995.00Team members (first three)/Spouse: $1195.00 – (for additional over 3 team members) $995.00

*Registration fees are subject to GST and are in Canadian Dollars.**Certain criteria applies.

A percentage of the registration fees will be donated to the Tooth Fairy Children’s Foundation.

PLUS – LEADING minds in Business Growth, Entrepreneurship, DENTAL Technology and much more...

Mr. Andrew McAfee Cofounder of MIT’s Initiative on the Digital Economy, (part of the MIT Sloan School of Management).

Dr. Jonathan FerenczClinical Professor of Prosthodontics,New York University College of Dentistry

Mr. Verne HarnishAuthor #1 best-selling business book “Scaling Up”

Dr. Brent BoyseOral and Maxillofacial Surgeon

Mr. Vince Barabba Former Kodak Executive & Author of “The Decision Loom: A Design for Interactive Decision-Making in Organizations”

Mr. Ron HuntingtonOwner, Executive Mentors & Trainers

Dr. Joe BlaesPast Editor of Dental Economics

Mr. Avi KopelmanCO-Founder of Cadent, Inventor, VP and Chief Scientist of Align Technologies

Dr. Fred Li Dentist

Mr. Albert GiraltPresident, Grup Villardel Purti

Mr. Rune Fisker VP Product Strategy, Business Unit Director, Dental Lab and Dental Clinic

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Troubleshooting Flexible Partials: Challenges and Solutions Gary Wakelam, RDT, CDT

Twenty-first century materials and techniques have made the creation of flexible partial dentures easier and more reliable than ever before. Yet, what happens during impression-taking, making a model, writing/reading the prescription, or when placing the prosthesis are all possible critical factors that can dramatically impact on the quality of the final prosthesis. The following is a summary of some of the common “challenges” I have been asked about over the years. As you will see from the “Solutions”, this list covers aspects of the process right from the start through to final placement of the prosthesis and beyond.

Challenge: Appliance requires re-polishing.Solution: Re-polishing can be done with Coarse Pumice and Brown Tripoli using a soft rag wheel.

Challenge: Clasps tight or loose.Solution: If patient senses any discomfort because of tightness of clasp, clasp can be loosened slightly by immersing area of the partial in hot water for 30 seconds and bending clasp outward. If clasp requires tightening, clasp area may be immersed in hot water and bent inward slightly to tighten. IMPORTANT: Please remember that clasps have been crafted in the exact proportion for proper function. DO NOT reduce clasp thickness at chairside. This could jeopardize strength and/or retention.

Challenge: Appliance requires adjustment (Reduction of periphery edge, relief in tissue-contacting areas, and relief in supporting areas to relieve tightness).Solution: Cannot adjust these materials in same fashion or using same instruments and burs used for acrylic. Adjustments can be made with either stones or rubber points. Rubber points and wheels will provide the smoothest surface (especially when adjusting the peripheral edges of the prosthesis) and are ideal for accessing undercut areas. Use a rapid motion (with a light touch) and continuously vary the contact point. NOTE: Carbide or acrylic burs are not recommended, as they tend to melt rather than cut the materials.

Challenge: Inadequate occlusal clearance between the arches.Solution: Flexible partial materials rely solely on mechanical retention to retain the teeth (unlike chemical bond with acrylic dentures). Good rule of thumb is 5 or more mm of posterior interocclusal space.

Challenge: Remaining dentition extremely flared out.Solution: Most esthetic clasp systems contraindicated in this situation.

Challenge: Adding tooth to partial.Solution: Remove all pastes or adhesives from tissue-surface of partial before taking

impression. Take alginate impression with partial in place in mouth. Make

sure partial fully seated in impression material. Remove with partial still in

impression. Pour model promptly and forward to laboratory with instructions to add teeth or teeth and retention (if necessary).

Challenge: Relining Partial.Solution: Relines are

infrequent with NaturalFlex II or Valplast due to their ability

to adapt to subtle changes in the mouth. If indicated, remove all

adhesives from tissue side of partial. Take rubber-based wash impression in closed mouth position, then take alginate

pick-up impression, pour immediately and send to laboratory.

Challenge: Short impressions or distorted soft tissue.Solution: Ensure full mouth impression taken (using a high quality alginate – most other impression materials compress the tissue too much, leading to increased adjustment time) with all teeth and anatomical landmarks reproduced. For an upper partial, make sure the palate is included in the impression. For a lower partial, ensure full extension of the impression including retromolar pads.

Challenge: Prosthesis is distorted.Solution: Material is thermo sensitive. Do not exceed a temperature of 107º F (42º C) either in-office or at home. Clean with water and use of non-abrasive materials. Do not use ultrasonic equipment with acids that can modify material requisites. Product is not resistant to strong oxidizing chemicals or to strong (pH<4) acids.

Challenge: Prosthesis surface rough or etched.Solution: Instruct patients not to clean prosthesis with abrasive products; or with products meant for cleaning acrylic resin or metal prostheses; only use normal products for oral hygiene. Wash prosthesis with cold water only.

Conclusion

The old adage that “an ounce of prevention is worth a pound of cure” is very applicable with resolving many of the challenges presented. Sometimes it requires a basic change in technique, sometimes it involves adding a step to avoid larger problems later on. In any event, a little care often pays off in big improvements in the final result with Flexible partials.

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Presently, the majority of single-tooth implant restorations are designed to be delivered as cement-retained restorations that are cemented intraorally. This has been the case for many years, and I will venture to say that this will not change in the near future. However, peri-implantitis has become a reality, and is something many practitioners are dealing with in their practices. Clinical research and empirical data have both linked retained cement around implant restorations to symptoms consistent with peri-implantitis: bone loss, tissue loss, inflammation, infection, etc. Furthermore, with the use of stock abutments, cement lines have become very difficult, to almost impossible, to properly clean, leaving retained cement around the crown-abutment margins, and often more apically.

Now, this issue with cement-retained implant restorations was not something that I was willing to accept in my practice. Furthermore, the advent of monolithic restorations (IPS e.max® & Zirconia), and the use of titanium abutmentsor bases created the ability to provide a new type of implant restoration: the “Screw-mentation” implant restoration.

This type of restoration is truly a cemented restoration, where the steps of its delivery are done out of order. A monolithic (could utilize some porcelain veneering) restoration is fabricated with a screw-access hole through the

occlusal aspect of the crown, which coincides with the screw-access hole on the custom titanium abutment or base. The crown is then cemented onto the abutment/base outside of the mouth, with any cement that would occlude the screw access hole being removed. This now creates a screw-retained restoration that is delivered as such. Essentially, it is a cemented restoration that is delivered as a screw-retained restoration. This is an important point due to the fact that a classic screw-retained restoration would involve the stacking of porcelain onto a titanium, precious metal, or zirconia abutment. This type of restoration would have completely different properties compared to a “Screw-mentation” restoration, and would be much more prone to chipping. With the use of monolithic restorations, porcelain chipping is virtually eliminated. And, when combined with a titanium abutment/base, this now becomes the strongest implant restoration we can make today.

Finally, with the ability of utilizing new “angled screw-channel” technology, “Screw-mentation” restorations can routinely be completed in both anterior and posterior areas. It has now become the main type of implant restoration utilized in my practice. And most of all, it completely eliminates the possibility of any excess cement becoming trapped around the implant or abutment. This is very important in today’s dental implant practice.

The Art of “Screw-mentation”Eliminating Cement Issues in Implant RestorationsDr. Bobby BirdiDMD, Dip. Perio, Dip. Prosth, MSc, FRCD(C), FACP, DABP

Dr. Birdi is one of North America’s very few Certified Dual Specialists in Periodontics and Prosthodontics, and the first and only specialist in the world to attain Canadian and American board certifications in both Periodontics and Prosthodontics.

He received his dental degree from the University of Saskatchewan and his post-graduate specialty training in both periodontics and prosthodontics from the University of Minnesota. He is a Fellow and Examiner for the Royal College of Dentists of Canada, and a Diplomate of both the American Board of Periodontology, and the American Board of Prosthodontics. He is also an active member of the Canadian Academy of Periodontology and the British Columbia Society of Periodontists, as well as the Association of Prosthodontists of Canada and British Columbia Society of Prosthodontists. Dr. Birdi is a member of the American Academy of Implant Dentistry, the International Congress of Oral Implantologists, the Academy of Osseointegration, and the International Team for Implantology. He is well-published in the areas of dental implants and surgery. Dr. Birdi is a reviewer for the Journal of Oral Implantology, Clinical Advances in Periodontics, and the International Journal of Oral & Maxillofacial Implants (JOMI). Dr. Birdi is an adjunct Associate Professor at the University of British Columbia and the University of Minnesota. He also actively lectures both nationally and internationally in the fields of implant surgery and prosthetics, as well as aesthetic dentistry. Dr. Birdi is presently the co-director of the Pacific Institute for Advanced Dental Education located in Vancouver, Canada. He is also currently practicing at the BC Perio Dental Health & Implant Centres in Vancouver, Canada. His practice focuses on comprehensive periodontal and prosthetic treatment with a major focus on esthetics and implant dentistry.

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p Monolithic IPS e.max crown with access hole and Core3dcentres gold-anodized custom abutment.

p Crown cemented onto titanium abutment extraorally

p “Screw-mentation” restoration delivered intraorally

p “Screw-mentation” restoration occlusal view.

p Monolithic IPS e.max “Screw-mentation” restoration radiograph.

p Monolithic Zirconia “Screw-men-tation” restoration radiograph.

Benefits of the “Screw-mentation” restoration

1. Elimination of retained cement2. Retained benefits of a cemented restoration3. Easily retrievable restoration 4. More timely delivery of posterior restorations5. Very strong implant restoration 6. Elimination of porcelain chipping issues7. Less costly than traditional PFM restorations

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Connect with us on @aurumgroup

Taking photos in the day-to-day course of practicing dentistry is now commonplace in the dental practice. As the techniques and tools used to capture these images evolve, it is also important to bear in mind why we are taking the photos: to keep a record of, and to communicate, the patient’s situation (initially and as the case proceeds) over time. Great, and comprehensive photos, mean great communication with Patients (current and prospective from a marketing viewpoint), the Lab or other external service suppliers like Invisalign and others.

For the purposes of this article, we’ll look at communication between practitioner and dental technician as our focus. The American Academy of Cosmetic Dentistry (AACD) has proposed a series of 12 standard intraoral and extraoral views as illustrated in EXHIBIT 1. This is a great place to set as our photo requirement baseline. Now, let’s add other photos to this baseline AACD list that really help us create an outstanding final result for yourself and your patient:

• Pre-operative upper and lower arches• Preparation showing the dentin shade • Temporary • Final shade with shade guide or shade wave • Level occlusal plane – with teeth slightly apart, utilizing cheek retractors • Gingival symmetry • Symmetry or stick bite

Effective Communication Between Clinician and Technician

Photography 101- Great Photos tell a thousand words!Ulf Broda, CDT, RDT, LVIF

Manager, Neuromuscular and Comprehensive Aesthetics, Aurum Ceramic

Here are a few general tips based on all of the hundreds of photos we see every day:

• Take photos from directly in front of the patient, not standing beside the patient. If you are to the side the patients has to turn their head, causing distortion on either the left or right hand side of the photo.

• Have the patient sit upright in chair so the photo captures their full picture.

• For the symmetry or stick bite photo, have the patient out of the chair standing upright with their head straight, not tilted to left or right.

• Dual-side flash is preferred, with a polarized filter to eliminate glare from the flash. This will prevent flash from altering colour and translucency of the teeth.

• Do not use intraoral cameras for these photos. They tend to supply photos with a distorted “fisheye lens effect” and do not show the technician true colour, gingival symmetry, etc.

• Good clear 1:1 ratio photos give the technicians a lot of very valuable information, especially with comprehensive smile designs.

• Excellent quality, accurate photos are a must for single anterior teeth if they are to match adjacent teeth for color, symmetry, etc.

p Photo of preparation with shade tabs

p Symmetry or stick bite photo.

EXHIBIT 1AACD Suggested Photo Series

Non-retracted Views1. Natural Full Face – frontal angle 2. Full Natural Smile – frontal angle 3. Full Natural Smile – right lateral angle 4. Full Smile – left lateral view

Retracted Views5. Upper and lower teeth slightly parted – frontal view 6. Upper and lower teeth slightly parted – right lateral 7. Upper and lower teeth slightly parted – left lateral 8. Maxillary anterior in view only – frontal view 9. Maxillary anterior in view only – right lateral 10. Maxillary anterior in view only – left lateral

Retracted Views using a Mirror11. Maxillary arch – occlusal view 12. Mandibular arch – occlusal view

There is another aspect that we run into from time to time: the “size” of the photo files. Cameras in the dental office are often set at the lowest possible resolution setting to try to get as many photos in at the smallest possible file size. Great for efficient storage but not so good for accurate representation of colour/hue, details in the dentition OR if you decide to publish the case as an article or even in marketing materials down the road. We always recommend that you set your cameras at slightly higher than a basic “resolution” setting. Exact camera settings and terminology for this will vary by type of camera used but I think the caveat “I may want to publish this article” should be kept in mind for every photo you take. A higher “resolution” setting will result in larger photo file sizes but it will also usually provide sharper, more detailed photos (all other things being equal). As a further step, computer-automated shade matching programs (like ShadeWave) mathematically correct photos in real-time and provide the perfect shade translucency & value for the technician.

Please bear in mind that individual clinical situations may require additional photos to get across your message to the technician. It is never “wrong” to send extra photos!

Sending Photos to the Lab

As of January 2014, it has become law that confidential patient information (such as photos) must be transmitted between health care professional in a manner that is HIPPA and PIPEDA complainant. The Aurum Group® provides access to Brightsquid Secure Mail free of charge to its clients to satisfy this requirement. For more information and to join Brightsquid, please email me at ulfb@aurumgroup.com.

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The Economics of SleepErin E. Elliott, DDS

While attending a recent Post Falls, ID Chamber Business Fair, the powers that be placed our practice right across the way from a health insurance company. Some call it chance, but I call it destiny. The vice president of the health insurance company was up from headquarters visiting our area and decided to stop by his booth at the Expo. [Just as an aside - Believe it or not, I actually like going to expos. Not only do I go to promote my practice and the Dental Sleep Medicine in my practice, I go to interact with the community. My staff and I always have fun]. Never the wallflower, I started telling him all about how dentists can work with medical physicians in screening and treating sleep apnea. He was intrigued as he didn’t realize dentists could bill medical insurance for oral appliances or even what oral appliances were. Of course I told him the health consequences of untreated sleep apnea, but mostly the economics of untreated sleep apnea. As we were talking, a gentleman came up and said to my assistant, “I just found out I have that sleep apnea and need to get that C-PACK thing (remember we are in Idaho). Except I can’t afford it because I just had a $50,000 open heart surgery and I don’t think I could ever wear a mask on my face.” Mr. Vice President’s eyes lit up, he looked at me and he said, “I get it now.” Could the timing have been any better? Could we have prevented an open heart surgery? No one really knows that for sure but it’s possible.

A 2012 study from Birmingham, England1 showed that sleep apneics, when found prior to having overt cardiovascular disease, were still found to have cardiac structural and functional abnormalities. These same patients were found to have improvement in their cardiac function and blood pressure after C-PAP treatment for 6 months. The key here is early intervention and treatment that patients will comply with. Otherwise untreated moderate-to-severe sleep apnea has been estimated by a 2010 Harvard Medical School study to have a $65 billion - $165 billion impact on our economy.2 Yes… that’s BILLION.

Despite estimates of sleep apnea being more prevalent than asthma and diabetes, when was the last time you saw a “Sleep Apnea Awareness 5K Run” or a “Would you like to contribute to Sleep Apnea Awareness today?” at the checkout line at the local grocery store? Yet, if we only look a little further at our dental patients and work in conjunction with our local medical community, we could have a big impact in our community and in our country.

A recent 2013 article in Pulmonary Medicine3 showed that untreated Obstructive Sleep Apnea (OSA) doubles the medical expenses in a patient mainly due to cardiovascular disease. Another study showed that the number of physician visits was 3.46 higher in the year before diagnosis and decreased over the next 5 years by 1.03 and physician fees were higher by $148 and decreased over the next 5 years by $13.92.4 Physicians identifying patients has always been one major roadblock. When the Union Pacific Railroad Employees Health Systems focused on a sleep disordered breathing campaign with their physicians, it led to a measurable decrease in medical expenses.5 Our undiagnosed and untreated sleep apneics cost $45- 80 billion annually in additional medical costs.

Obviously, if a patient is sicker they will utilize physicians and more medial resources, but part of the estimate of the economic impact by the Harvard study includes OSA-related traffic accidents: a 12 - 39 billion dollar impact. Despite the national attention given to seat belts and drunk driving, untreated OSA patients are 2-3 times more likely to have a traffic accident. Drowsy drivers beware! Just ask Tracey Morgan. In addition, workplace accidents and workplace absenteeism place a huge burden on our productivity as a nation. $10-35 billion are lost annually as employees call in sick, cause an accident or are even less productive due to their daytime fatigue.

Recently, I have had several patients come to my office desperate for help. They needed to do something because they were unable to tolerate their C-PAP no matter how hard they tried. They were about to lose their job because they fell asleep everyday at work even after a full 8 hours of “sleep”. But was it quality sleep? Could you imagine if I started dozing off with a high-speed handpiece in my hand? I think I would lose my job for sure.

Secondary and societal effects of untreated OSA are difficult to quantify, but the divorce rate is 3 times the average in marriages with a partner that is not treated. Depression, fatigue, irritability, memory and judgement problems, family discord, etc. round out the list. I once treated a man where the only reason he pursued treatment is so that he wouldn’t be called “Grumpa” anymore by his grandchildren.

As exhaustive as the Harvard study was, oral appliances were not mentioned and dentists were not included in the “economic stakeholders” team. We, as a dental team, are in a perfect position to help. We stare at airways all day long! As healthcare providers we can observe medical histories and dental and anatomical abnormalities that give us clues that our patients may have OSA. Exhibit 1 gives a quick checklist on “What to ask yourself at the next recall exam”. Try it, you’ll be amazed at what you now note.

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Erin E. Elliott, DDS Born and raised in Southern California Dr. Erin Elliott attended dental school at Creighton University in Omaha, NE where she graduated in the top 5 of her class. In private practice in Post Falls, Idaho, she focuses on a wide range of aspects in her private practice including general and cosmetic dentistry as well as orthodontics. Dr. Elliott has a special interest in screening and treating snoring and sleep apnea. She is an active member of the American Academy of Sleep Medicine and American Academy of

Plan to Attend

“Sleep Apnea - Wake Up to the Problem”with Dr. Erin E. Elliott

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: ce@aurumgroup.com.

Dates subject to change. Please call to confirm course dates.

Dental Sleep Medicine and has authored several articles on Dental Sleep Medicine, including her latest articles published in Dental Economics entitled “Take the Time to Check for Sleep Apnea” (October 2012) and “Pediatric Sleep Apnea” ( June 2013). She is considered a national expert in this growing field of dentistry and has lectured extensively educating dentists on how to incorporate dental sleep medicine into their practices.

1 Stiles S. CPAP Improves CV Structural, Functional Changes Due to OSA. Medscape. Mar 15, 2012.2 The Price of Fatigue: The surprising economic costs of unmanaged sleep apnea. Harvard Medical School: Sleep Medicine Department. Dec 2010. 3 Tarasiuka, A, Reuveni, H. The Economic Impact of Obstructive Sleep Apnea, Curr Opin Pulm Med. 2013; 19 (6): 639-644. 4 Albarrak M, Banno K, et al. Utilization of health-care resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP. Sleep. 2005 Oct; 28 (10): 1306-11. 5 Potts KJ, Butterfield DT, Sims P, et al. Cost savings associated with an education campaign on the diagnosis and manage-ment of sleep-disordered breathing: a retrospective, claims-based US study. Popul Health Manag 2013; 16: 7-13. 6 US Market Deep Dive Analysis, 2013.

What to ask yourself at the next Recall Exam:Signs of Hypoxic distress

• Fatigue• High blood pressure• Poor concentration• Bags under the eyes• Snoring

Signs of Airway distress

• Vaulted arched palate• Narrow arch• Large neck• “Uvula engorgement”• Mouth breathing

Signs of Dental distress

• “Turkey waddle”• Retrognathic• Bruxism• Erosion• Scalloped tongue

Consider a recent market analysis that observed that when patients were sent for an overnight sleep study, 30% choose not to go. We know that 82% of these patients would have tested positive but when asked why they didn’t go, half of them said it was because they knew they wouldn’t wear a mask and some of the others stated they didn’t want to sleep in a strange place.6 With the advent of home sleep tests and oral appliances as a viable treatment option, we could not only have a huge impact on our patients’ quality of life but also our nation’s bottom line.

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Looking for New Patients? Understanding and identifying patient’s touch points may help. Touch points are any methods or modes of contact between the practice and the patient. They can be face-to-face discussions, promotional fliers, or technology driven information. Most practices want to improve customer satisfaction, but unless you have your patient in mind at every touch point, there’s a chance you’re dropping the ball.

Identifying your touch points is the first step toward tracking a patients journey and making sure they are satisfied every step of the way. How do you do that? Start by listing out the different points of contact you have with your current, and potential, patient base. This basic list is invaluable in insuring that you don’t miss an opportunity to “WOW” your patients at each possible stage of their contact with your practice. EXHIBIT 1 below shows simple example of just such a list.

A list like this is a good start, but it’s not one-size-fits-all. Just as important, each of these touch points can have a lot of underlying pieces.

What’s the secret to success in creating and maintaining effective touch points? Measuring patient satisfaction. You may work hard at each touch point and have great ideas but what matters most is listening to your patients to make sure all those good ideas are working. Of course, it is one thing to measure patient satisfaction through feedback surveys but another to set goals and make improvements. In order to do that you must set benchmarks. What is benchmarking? The best example is: you may want to lose weight so you step on the scale and say “I’m 10 more pounds than last year”. Your old weight is the benchmark, and any measurement that deviates from that benchmark, good or bad, helps you measure your progress and set a goal. In order to set a goal in the first place you need to know where you stand. Well-designed and regular patient surveys can provide you with invaluable feedback on where you are today – and what needs to be improved to get where you want to go.

The simplest test: take a hard look at your patient’s journey and determine if you would want to be a patient in your practice.

Touch PointsBring Your Patients’ Experience to LifeSherry Blair, Dental Management Consultant

As Director of the Dynamic Team Program at the Las Vegas Institute, Sherry Blair shares her more than 37 years of experience managing each and every system within the dental practice. Sherry has combined her acquired knowledge and personal experience to create an inspired, effective and motivated curriculum that refines the systems surrounding the patient’s total experience in a dental practice. Sherry’s extensive exposure to most forms of practice management and dental systems, as well as her strong focus on patient satisfaction, make her uniquely qualified to enhance the effects of any dental practice.

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EXHIBIT 1Possible Patient Touch Points

Before During After

Social media Approach of facility Follow ups

Testimonials First phone call Thank you cards

Ratings and Reviews Appearance of reception area Referral gifts

Web site New Patient Interview Feedback surveys

Community involvement Financial Presentation Newsletters

Plan to Attend

“Creating Patient Satisfaction: Productive Team Meetings”with Sherry Blair

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: ce@aurumgroup.com.

Dates subject to change. Please call to confirm course dates.

Visit us at www.aurumgroup.com Connect with us on @aurumgroup

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*Designed and Manufactured in North America

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