Wallace Workshop 6490 Wednesdy AM

8/10/2019 Wallace Workshop 6490 Wednesdy AM

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Full Dentures In A Single One Hour Visit: No Dental

Laboratory Needed

Lawrence N. Wallace, D.D.S.

Wednesday

December 4, 2013

THE LARGEST DENTAL MEETING/EXHIBITION/CONGRESS IN THE UNITED STATES


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General Registraon HoursFriday, November 29th 12:00 Noon - 4:30 P.M.

Saturday, November 30th 8:00 A.M. - 4:30 P.M.

Sunday, December 1st- Tuesday, December 3rd

8:00 A.M. - 5:30 P.M.

Wednesday, December 4th 8:00 A.M. - 4:30 P.M.

Special EventsDinner Dance - November 30th- Ticket 2010

Wednesday Night Happening - December4th

New York Marrio Marquis Hotel

Educaonal Audio RecordingsRecordings of selected programs may be purchased

at the Strategic Events Plus booth outsideClassroom 1E18

Exhibit Hall HoursSunday, December1st- Tuesday, December3rd

9:30 A.M. - 5:30 P.M.

Wednesday, December4

th

9:30 A.M. - 5:00 P.M.

TicketsTickets for all funcons can be purchased atall general registraon booths located in the

Registraon Area on the Upper Level in the CrystalPalace and online.

New Programs

Welcome to the Greater New York Dental Meeng

Botox and Facial FillersSeminar & Workshop

Days of Educaon Seminars,ands-on Workshops & Essays

Friday - Wednesday

Doris Kearns Goodwin

Monday, December 1st

12:00 - 2:00 - Ticket 401

$85.00

2013Celebrity Luncheon Spea

SundayScienc Poster Sessions

4 Days of ExhibitsSunday - Wednesday

Sixth Annual

NVISALIGN- GNYDM EXPO4 Days of Programming:

Sunday - Wednesday

VOCO America, Inc.Dr. Robert A. Lowe

Restorave

Philips Sonicare &Zoom Whitening

Dr. Gerard KugelWhitening

VOCO America, Inc.Dr. Robert A. LoweFixed Prosthecs

OcoBioMedical, Inc.Dr. Charles D. Schlesinger

Implants

Millennium DentalTechnology, Inc.Dr. Charles Braga

Lasers

Millennium DentalTechnology, Inc.

Dr. Alex TouchstoneRestorave

Bisco & ShofuDr. Jack D. Grin, Jr.

Esthecs

Hiossen, 3D Diagnosx &Planmeca

Dr. Aeklavya PanjaliImplants

10:00 - 12:30 10:00 - 12:30 10:00 - 12:30 10:00 - 12:30SUNDAY MONDAY TUESDAY WEDNESDAY

FREE Live Dentistry Hi-Tech 430 Seat Arena

2:30 - 5:00 2:30 - 5:00 2:30 - 5:00 2:00 - 4:30

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www.larelldentures.com

Greater New York Dental Meeting

The Larell One Step Denture: The Alternative Denture

Lecture Notes:

Introduction Speaker background

History of dentures Denture demographics and usage

Scientific background Classic Prosthodontic Literature Principles of Successful Dentures

The Larell One Step Denture Indications for usage Denture technique

Case Studies Complete Denture Upper/Lower Immediate Denture Implant Overdenture All on Four provisional denture

Summary

Q and A


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The Larell One Step Denture Technique the Fabrication Process

Pocket Guide

1. Choose the proper template size from the preliminary model

2. Modify template on model and in mouth

3. Functional In mouth reline process

4. Finish, Polish and Deliver


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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation

Slide 1

CompleteDenturesinAnHour

1

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Slide 2Speaker Lawrence N Wallace DDS

DDS University of Illinois College of Dentistry 1970

Oral Surgery Residency Long Island Jewish Medical Center 1973

Board Certified Oral and Maxillofacial Surgery 1978

Private Practice 1973-1995

VP Dental utilization review firm 1997-1999

President and CEO, Larell Surgical Consultants 1999-present

Developer and Founder, The Larell One Step Denture 2005

Winner, Monterey Bay Region Business Plan Competition 2010

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Slide 3Discussion Points

Introduction Scientific background Indications for use The Larell One Step Denture Case Studies Summary

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Slide 4The History of Dentures

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Slide 5Why Wear Dentures

Poornutrition

Nodentures

Increasedchronicdisease

Higherhealthcare

costs

NutritionHealth

QualityofLife

SelfEsteem

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Slide 6Denture Demographics

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2010 2020

Millions

Denture

Patient

Market

Size(Millions)

USMarket GlobalMarket

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Slide 7Denture Usage

33-37 Million edentulous currently in the US

Only 90% of the edentulous wear dentures

The percentage decline in edentulism will be morethan offset by the 79% increase in the adultpopulation over 55.

Dentists will find a sizeable minority of the patientpopulation will continue to need complete dentureservices.

Will there be a need for complete dentures in the United States in2020?

Douglass CW Shih A Ostry L J Prosthetic Dentistry 2002 Jan;87(1):5-8

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Slide 8Denture Demographics

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38.5 million over the age of 65 with anedentulous rate of 22.9% or 8.86 millionIncome: < $10k = 18%

$10-29k = 12%$30-50k = 6%> $50k = 4%

Men > WomenRural > UrbanLess Educated > College Education

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Slide 9What Makes A Successful Denture

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Principles of Denture Fabrication

Fit Form Function

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Slide 10Scientific Principles of Complete Dentures

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Critical Clinical Definitions: Support The quality of a denture to

resist displacement by functionalstresses.

Retention- The resistance of a

denture to removal in a directionopposite that of its insertion.

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Boucher CO Prosthodontic Treatment for Edentulous Patients11th Edition 1997a definitive impression is one of the most critical stepsin thefabrication of complete denturesFrank RP DCNA 1970the key to obtaining a good final impressioncorrectlyextended and properly relieved trayEl Khodary et al JPD 19851.3mm relief of denture for materialRussell A JPD 1959second molarsometimes must be eliminatedKapur KK et al JPD 1965number of posterior teeth didnt affect chewing efficiency

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Wright CR J PD 1966ability to wear a lower denturea normal tongue positionthe occlusal plane is 2 mm below the retromolar padSchiesser FJ JPD 1966 The shape of the polished surface contributes more to thestabilization of a denture than the border of the denture the artificial teeth must occupy a position so that t he tongueis pressed inward with just as much force as the cheek ispressed outwardTrapozannoV JPD 1959there is little difference between 20 degree vs non anatomicalteethlittle less efficient but felt better

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Jones PM J ADA 1972monoplane teeth suffer less of a derangement of occlusalrelations Anatomic teeth will suffer heavier forces on the forward facinginclines of the lower teeth against the distal inclines of the upperteeth. This results in a sliding of the weaker denture base on themucosa causing inflammation, pain, bone destruction, andtissue hyperplasiaset maxillary posterior teeth firstmaxillary teeth are arranged with regard to appearance

Felton DA Texas Dental Journal Apr 2010complete edentulism continues to represent a tremendousglobal health care burden, and will for the foreseeable future.

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Slide 14Standard of Care The Larell Denture

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Adherence to Scientific Principles andclassic prosthodontic literature

Professionally accepted materials Patient satisfaction results

Fit Form Function

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Slide 15Dental Marketing 101

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Slide 16Patient Expectations

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It isnt all about the

occlusion

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I hope you can do better than the last dentist Ihad!

I cant chew lettuce, apples or corn on thecob!

The lower ones moves when I eat!

My food tastes different!

My speech has changed some!

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Dentures are not areplacement for teethThey

are a replacement for NO

teeth

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Slide 23The Larell One Step Denture

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Dentures in an Hour

Do they meetStandard of Care ?

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Slide 24Standard of Care

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STANDARD n. that which isestablished by authority, custom,or general acceptance as a model;criterion.

*guides practice and may be used to evaluateperformance

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Slide 25The Larell One Step Denture

Innovative method of denture fabrication

Lower-cost, one-visit solution

Opens unserved and underservedmarkets due to its:

Portability

One visit fabrication Intuitive, easy to learn technique

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Slide 26Indications for Use

Complete Dentures Upper/Lower

Immediate Dentures

Implant Overdentures

Immediate

final

Additional uses

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Slide 27Market Sectors

Private Practice

Skilled Nursing Facilities

Assisted Living Residences

Working population without insurance benefits

Mobile Dental Clinics

Safety Net Clinics

Mission of Mercy dental clinics

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Slide 28Larell Dentures utilize Classic Prosthodontic

Principles

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There are three posterior teeth The teeth are over the ridge The impression is most accurate, done direct Lingual flange concave for better retention Maxillary occlusal plane set first for

appearance Monoplane teeth for maximum comfort and

least tissue damageAdapted template allows for proper thickness

of reline material

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Slide 29Factors associated with Successful Dentures

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76.7% satisfied with their dentures 74.6% expectations had been meet 67% said they adjusted easily at 6 month 78% said they adjusted easily at 18 months Age, gender, race, income level, education,

marital status and maxillary and mandibularanatomy were not significantly associated withdenture success within this study

Roberta L.Diehl, Ulrich Foerster, Venitta Sposetti, and TeresaDolan Journal of Prosthodontics, Vol 5, No2 (June), 1996, 84-90

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Slide 30Survey of Larell Denture Patients

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69 patients surveyed: 61 responding Telephone interview and post-op evaluation 11% previous denture wearers 83.6% overall satisfaction with their dentures 98.4% pleased with appearance 80.3% chew comfortably 83.3% reported feeling healthier Patient demographics consistent with previous

study

Mastication difficulty reported with apples and corn on the cob

Treated by Dr Alouf and Dr Miller in Bristol VA DPH project

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Slide 31Conventional Denture vs. Larell Denture

Made in dental office

C on ve nt io na l d en tu re L ar el l On e- St ep De nt ur e

Made in 4-5 visits

Can be made anywhere

Made in 1 visit

Total time 3-4 hours

$200 - 400 lab cost

Retail $3000-5000 per set

Total time about 1 hour

No lab cost

Sugg Fee $1,200 per set

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Slide 32Larell Results

RAM/MOM VA Clinic August 2011 100 dentures

VA Dept of Health clinic August 2011 92 dentures

Sacramento CA CDA clinic Sep 2012 86 dentures

VA Dept of Health clinic Feb 2012 70 dentures

Roanoke VA MOM Clinic Apr 2012 78 dentures

San Jose CA CDA Clinic May 2013 104 dentures

All done in 1 - 2 day clinics

All completed to patie nt satisfaction

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Slide 33Our Patients

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Slide 34The Larell One-Step Denture System

Multiple size pre-formed patented dental templates

Available in shades B65, B1

Accommodates 99% of edentulous population

Templates made in the US from all US made materials

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Slide 35Denture Placement Technique

Check vertical dimension in standing relaxed position

Final vertical to be 2 mm less than initial measurement

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Start with quick set stone model

Choose closest template size

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Trim flanges to allow 2-3 mm of space between the edge offlange and height of mucobuccal fold

Frenum attachments and other impingements on thetemplate are relieved at this time

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Palate is adapted to close fit

Reduce posterior border to vibrating line

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Position upper template in mouth

Anterior/posterior (ala t ragal line): Occlusal plane

Occlusal cant: Occlusal plane

Tooth Show: Visual

Lip Support: Visual

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Slide 40Templates-Before and After

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Slide 41Complete Larell One Step Denture

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Slide 46Template Customization

Teeth not over ridge Heat template and move teethslightly. If more movement is needed then cut notch intemplate and move segment over ridge.

Occlusal plane canted on template try in Place stopsinside upper template to level occlusion prior to reline.

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Slide 47Template Modification

Unable to achieve ideal class I occlusion Not allcircumstances will allow an ideal class I occlusion. Theremay be a posterior crossbite or edge to edge occlusion.This is not an issue with monoplane teeth

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Slide 48Modifications

Poor retention of lower template Use soft reline material,add mylohyoid flange extensions, consider the use ofmini implants.

Gingival color too light Add ink to reline liquid beforemixing

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Slide 49Cosmetic Dentures

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Slide 50Case Study

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Maxillary ImmediateDenture

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Slide 51Placement Technique Immediate Denture

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Vertical already established Lower occlusion to be balanced to upper

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Slide 52Placement Techniqu e Immediate Denture

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Slide 55Case Study

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Maxillary ImmediateDenture

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Slide 56Case Study Immediate Interim Denture

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Slide 60Case Study

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Maxillary ImmediateDenture With Template

Modifications

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Slide 61Case Study Immediate Denture

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Slide 67Case Study

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Maxillary ImplantSupported Denture

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Slide 68Case Study Maxillary Implant Case

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Slide 70Case Study Maxillary Implant case

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Slide 74Case Study

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Mandibular ImplantSupported DentureWith Reinforcement

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Slide 75Case Study Mandibular Implant Case

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Slide 80Case Study

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All on FourImplant Reconstruction

Temporary Denture

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Slide 81Case Study All on Four Implants

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Slide 88 ___________________________________

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Slide 89The Real Economics

One Set of Larell Dentures

One hour of time Cost of templates and reline material $ 355.00 Suggested fee to patient $1200.00

Profit: $ 845.00/hour*

*Fixed Expenses not included

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Slide 90Grow Your Practice

Add patients you would not have seen Brings in family members and friends Promotes your practice as innovative

Sample increased gross income at $1200.00/set

Sets per week hours/week Additional Gross Income/Yr

1 1.5 $ 62,400.00

2 3.0 $124,800.00

3 4.5 $187,000.00

4 6.0 $249,000.00

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Slide 91The Larell Difference

Addresses major barriers to care of:ACCESS AND COST

Innovative one hour technique Intuitive, efficient easy to learn technique Affordable for patient Profitable for the dentist

Improvesnutrition

Improveshealth

&

quality

of

life

RaisesselfesteemLowershealthcarecosts

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Slide 92

Contact Information

Dr Lawrence WallacePhone 831.659.9300

[email protected]

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Wallace Workshop 6490 Wednesdy AM

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Transcript of Wallace Workshop 6490 Wednesdy AM