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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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Over 1,500 Exhibit Booths
FREELive Paent DentalTreatment on the Exhibit Floor
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CONE-BEAM
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Technology Pavilions
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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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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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40
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2010 2020
Millions
Denture
Patient
Market
Size(Millions)
USMarket GlobalMarket
6
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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
7
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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
9
Principles of Denture Fabrication
Fit Form Function
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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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Slide 11Scientific Principles of Complete Dentures
11
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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Slide 12Scientific Principles of Complete Dentures
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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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 13Scientific Principles of Complete Dentures
13
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
15
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 16Patient Expectations
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It isnt all about the
occlusion
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Slide 17Patient Expectations
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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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Slide 18Patient Expectations
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 19Patient Expectations
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Slide 20Patient Expectations
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Slide 21Patient Expectations
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 22Patient Expectations
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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
23
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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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
25
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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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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
33
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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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Slide 36Denture Placement Technique
Start with quick set stone model
Choose closest template size
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 37Denture Placement Technique
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
37
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Slide 38Denture Placement Technique
Palate is adapted to close fit
Reduce posterior border to vibrating line
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Slide 39Denture Placement Technique
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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 40Templates-Before and After
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Slide 41Complete Larell One Step Denture
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Slide 42Complete Larell One Step Denture
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 43Complete Larell One Step Denture
43
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Slide 44Complete Larell One Step Denture
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Slide 45Complete Larell One Step Denture
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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.
46
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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
48
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 49Cosmetic Dentures
49
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Slide 50Case Study
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Maxillary ImmediateDenture
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Slide 51Placement Technique Immediate Denture
51
Vertical already established Lower occlusion to be balanced to upper
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 52Placement Techniqu e Immediate Denture
52
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Slide 53Placement Techniqu e Immediate Denture
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Slide 54Placement Techniqu e Immediate Denture
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 55Case Study
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Maxillary ImmediateDenture
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Slide 56Case Study Immediate Interim Denture
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Slide 57Case Study Immediate Interim Denture
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 58Case Study Immediate Interim Denture
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Slide 59Case Study Immediate Interim Denture
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Slide 60Case Study
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Maxillary ImmediateDenture With Template
Modifications
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 61Case Study Immediate Denture
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Slide 62Case Study Immediate Denture
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Slide 63Case Study Immediate Denture
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 64Case Study Immediate Denture
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Slide 65Case Study Immediate Denture
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Slide 66Case Study Immediate Denture
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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 69Case Study Maxillary Implant Case
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 70Case Study Maxillary Implant case
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Slide 71Case Study Maxillary Implant Case
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Slide 72Case Study Maxillary Implant Case
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 73Case 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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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 76Case Study Mandibular Implant Case
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Slide 77Case Study Mandibular Implant Case
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Slide 78Case Study Mandibular Implant Case
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 79Case 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 82Case Study All on Four Implants
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Slide 83Case Study All on Four Implants
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Slide 84Case Study All on Four Implants
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The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
Slide 85Case Study All on Four Implants
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Slide 86Case Study All on Four Implants
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Slide 87Case 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
89
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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
90
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8/10/2019 Wallace Workshop 6490 Wednesdy AM
35/35
The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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
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