Perio Screening vs Assessment

November 7, 2018 Pankey Gram

Time is a major priority in the thriving dental practice. Balancing the need for comprehensive care with the efficiency necessary to get everything done in a day is a serious challenge. When it comes to periodontal assessments, the numbers today shockingly still show that a majority of offices are not routinely completing a perio exam.

It doesn’t have to be that way!

Implement a Quick Perio Screening

Consider making your life a lot easier while still improving patient care by offering periodontal screenings. An efficient screening that divides the mouth into scored sextants shouldn’t take more than a minute or two.

Your hygienists will appreciate the opportunity to show off their probing skills. They will be able to help patients recognize the signs of gingivitis and periodontal inflammation that may have gone unnoticed otherwise. If the patient scores high enough, then that will necessitate a full-mouth periodontal exam that includes full mouth probing furcation scoring and measuring muco-gingival attachment loss and recession.

This simple addition can lead to more dentistry in your practice and therefore higher production. That’s a boon for both patients and dentists, as the former improves their health and the latter is able to offer more complex treatment.

Periodontal disease is a sneaky, pervasive issue that can be detrimental to a patient’s entire health. Systemic diseases like atherosclerosis and diabetes have been associated with periodontitis. Gingivitis, while reversible, can still be exceedingly unpleasant and eventually lead to worsening periodontal health.

The way your hygienist educates patients about periodontal disease contributes to how patients understand the screening’s purpose. The hygienist must make it clear that you are checking for gingivitis and periodontitis because they can lead to pain and tooth loss. This would require much more invasive care in the long run.

Get our take on dental esthetics by reading this awesome Pankey blog here. Do you carry out perio screenings in your practice? We’re dying to know more, don’t be a stranger!

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The Patient’s Journey

October 24, 2018 Mark Murphy DDS

Providing healthier mouths to patients and doing more fulfilling dentistry (and making more money as a result) are admirable goals most practices have. I have written a couple of times about techniques that help us improve case acceptance: creating curiosity and co-discovery, listening, the learning ladder, and more.

This brief overview is an attempt to see the process as a journey for the patient and to consider their perspective:

Patient’s Journey: Eighteen Inches at a Time

It Starts in the Head

Patients first listen to the facts about dental care, their need and wants, issues or diseases that they have, and potential treatment solutions. Sadly, facts are not enough.

Developing great listening skills, caring, and trust help patients come to see you as their health advisor. This requires an eighteen-inch ‘Journey to the Heart’! It is there that caring and trust live. The emotional connection is very important in case acceptance. To ignore it is to minimize your success. But that too is not enough.

The patient must schedule, keep appointments, and pay for recommended treatment. This ‘Journey to the Wallet’ is the next eighteen-inch trip the patient must take. It is the execution of the plan from their perspective.

Valuing dental care and oral health is demonstrated by their checkbook and what they spend time and money on. Still not done?

The next eighteen-inches take us to a knee. Appreciation helps fulfill us as caregivers. Most rewards are best when they are balanced, financial, and behavioral: money and warm fuzzies, you get the idea. Money alone does not buy happiness (but it does help you enjoy your misery in some mighty fine places!).

The final journey takes us eighteen inches to the patient’s feet. When patients tell others about your practice and refer their friends, you have come full circle. This trust display is the ultimate compliment to you and your team.

Keep the Patient’s Perspective in Mind

Ask yourself the following and seek answers with your team to enhance patient health, your fulfillment, and mutual rewards:

·       Have you helped nurture movement toward the heart?

·       Did the patient accept and schedule treatment? If not, why not?

·       Were they able to pay with gratitude and appreciation? (borrowed from Dr. Pankey)

·       Did you ask for and receive referrals of their friends and family?

Remember, it’s a journey, not a destination. Enjoy the trip and check the map along the way. You, your team, and your patients will all be the better for it.

A journey is best measured in friends, rather than miles. -Tim Cahill

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Mark Murphy DDS

Mark is the Lead Faculty for Clinical Education at ProSomnus Sleep Technologies, Principal of Funktional Consulting, serves on the Guest Faculty at the University of Detroit Mercy School of Dentistry and is a Regular Presenter on Business Development, Practice Management and Leadership at The Pankey Institute. He has served on the Boards of Directors of The Pankey Institute, National Association of Dental Laboratories, the Identalloy Council, the Foundation for Dental Laboratory Technology, St. Vincent DePaul's Dental Center and the Dental Advisor. He lectures internationally on Leadership, Practice Management, Communication, Case Acceptance, Planning, Occlusion, Sleep and TMD. He has a knack for presenting pertinent information in an entertaining manner. mtmurphydds@gmail.com

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Master Wax Centric Relation Bite Record 2

October 15, 2018 Pankey Gram

Now that you have fabricated the platform, the next step is to capture the record with the patient. You will need a heat source and a blue Delar wax Pencil.

The first step is to heat the sides of the Master Wax Platform so they are tempered. Take the wax to the patient’s mouth and place it over the maxillary teeth. The anterior edge of the wax should be at the embrasure between the canine and the lateral. Bend the corners over the canines to help with retention. Press the wax against the teeth and ask the patient to close gently into the wax. Cool the wax with your air water syringe, have the patient open, and continue to cool the platform before removing from the mouth.

Using blue delar wax created a small bead where the lower canines have left an impression. Reseat the platform over the maxillary teeth and using bimanual guidance bring the lower canine cusp tips up until they just touch the blue wax. Have your assistant cool the wax with air. After removing the platform from the mouth add Delar wax where the second molars have left a cusp imprint. Then return the platform to the mouth and using bimanual guidance arc the patient into the wax so the lower molar cusp touches, then cool with air.

Your record should now be dropped into cool water. A disposable plastic container from the grocery works great. Write the patients name on it with sharpie marker and add it to their lab pan.

 

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Master Wax Centric Relation Bite Record 1

October 12, 2018 Pankey Gram

Analyzing a patient’s occlusion is key to providing optimal care. There are multiple ways to take a centric relation bite record, but one of the classics at Pankey has to be utilizing master wax. Easily mounting models in the laboratory is one of the main advantages of this method.

Although a slightly more challenging technique from a chairside perspective, it can still be accomplished with ease. Here is where to start:

Intro to the Master Wax Centric Relation Bite Record

Begin by gathering your necessary tools and materials. Start with a red master wax that looks just like baseplate wax from a standpoint of the size of the wax sheets, although it is different because it’s both softer and tackier. You will also need a blue wax pencil, scissors to cut the wax, a heat source such as an alcohol torch, and a way to light the heat source.

Take a single sheet of wax and temper it in the middle with the intention of being able to bend it in half. Once it is thoroughly tempered, bend it in half without cracking or breaking the wax. Make sure the bend is fairly crisp. After the wax has cooled a little bit, open it back up and cut it in half. Out of every sheet of wax, you should be able to generate two platforms for wax records.

Once again temper the wax halfway in the middle with the heat source. Tempering refers to heating to flexibility but not dripping. Again, fold the wax in half so you have a double thickness sheet. Then, cut the wax into the shape of the platform …

Look for the second part in this series about our master wax technique coming soon. And did you get a chance to read this Pankey Gram blog on enjoying Miami while you visit Pankey? Let us know what you think!

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Panadent Dento-Facial Analyzer Technique: Level Planes

October 7, 2018 Lee Ann Brady DMD

Function and esthetics are the two primary goals of excellent treatment. Achieving them both simultaneously requires the right tools used with the best skill possible. The  Dento-Facial Analyzer is my go-to for gathering information I can use to improve the outcome of mounting a maxillary model.

In parts 1 and 2 of this series, I introduced the Dento-Facial Analyzer and began the discussion of how to capture records with it. Here, I’ll complete my overview of a solid technique:

Completing the Dento-Facial Analyzer Technique

… Ensure the Dento-Facial Analyzer is positioned level to the horizon both when looking straight on at the patient’s face from the anterior section and looking at them from the side. It should be level in both planes of space. Then, allow the bite silicone to set and have the patient hold to verify.

Remember that the main use of the Dento-Facial Analyzer is transferring three significant pieces of information. This is either intended for the laboratory or for when we mount our own models.

The first piece of information is the maxillary relationship – the distance to hinge access – which means it’s very important that the central incisors on the maxilla are seated against the plastic bite plate.

Second, we are transferring information about the occlusal plane and the incisal plane. From an incisal plane perspective, it’s crucial that the plate is level to the horizon as we look straight on at the patient once we have the analyzer in. The vertical rod on the analyzer indicates the center of the face – the facial midline – which can be given by the central philtrum of the upper lip or the center of glabella.

You should also look at how you’ve captured the record from a lateral view. This ensures the occlusal plane – the relationship of the cant from anterior to posterior teeth that exists in the patient’s face – is transferred accurately to the lab or onto the articulator. The side bar of the Dento-Facial Analyzer should be level to the horizon.

Do you use this simple and accurate tool?

For a hands-on demonstration of the Dento-Facial Analyzer from Pankey educators, learn more about our Essentials 1 course.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Dento-Facial Analyzer Technique: Capturing Records

October 1, 2018 Lee Ann Brady DMD

You can gather accurate functional and esthetic information using the Panadent Dento-Facial Analyzer for restorative cases. I’ve found this tool particularly effective compared to alternatives such as the Facebow or stick bite.

If you haven’t done so yet, make sure to check out the introduction to this series on the Dento-Facial Analyzer. It includes background information, armamentarium, and key reasons why the device can elevate patient care.

Without further ado, the Dento-Facial Analyzer technique:

Essentials of Dento-Facial Analyzer Technique

Once you have the white disposable plate – which is actually the piece you will send to the lab once the record is captured – snapped onto the Dento-Facial Analyzer, use VPS tray adhesive to lightly coat the plastic tray. You are only going to do this from about the canine position posteriorly because you aren’t going to put silicone on the anterior portion of that bite plate.

Next, attach the vertical reference bar to the Dento-Facial Analyzer. Without bite registration on it, take it to the patient’s mouth and seat the central incisors exactly against the white plastic in the front labially.

Verify that you can hold this level to the horizon in two planes of space and that you can touch the patient’s teeth. If not, you might need to build up the posterior.

If you’ve verified this, put bite silicone on the plate from the canine position back, then seat it again, making sure the central incisors are seated labially against the white plastic …

I’ll round up this fun technique with Part 3 in the series coming soon.

For a hands-on lesson in the Dento-Facial Analyzer from our talented educators, check out our Essentials 1 Pankey course. Also, watch this video for a quick refresher or pre-course overview.  

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Panadent Dento-Facial Analyzer Technique: Introduction

September 21, 2018 Lee Ann Brady DMD

The Dento-Facial Analyzer is a marvelous tool I use in the practice to mount maxillary models. It has made a huge difference in my practice of dentistry and is one of my favorite tools to teach.

Introduction to the Dento-Facial Analyzer

For the critical aspects of diagnostics and sending info to the lab for the completion of a restorative case, mounting models appropriately is so important. They must be mounted in three planes of space referenced to hinge access to capture esthetic information including incisal plane and occlusal plane relative to the horizon.

Traditionally, this has been accomplished by utilizing a Facebow, Earbow, or by actually capturing hinge access position. Now, we have the option of using the Kois Dento-Facial Analyzer to capture both functional information and esthetic information that we would normally get with a Fox’s bite plane or stick bite. All of this functionality is managed with one simple device.

The Kois Dento-Facial Analyzer was designed based on scientific information gathered by Dr. John Kois, which shows that the distance from the incisal edge position of the maxillary central incisors to hinge access on average is 100 mm. Most people fall within a range of 5 mm to the average, therefore this is the assumption made when the device takes a record.

The armamentarium for record capturing with the Panadent instrument includes the analyzer, bite registration silicone in a gun with a tip, VPS adhesive used in an impression tray, and disposable bite plates that snap onto the analyzer (from the device manufacturer Panadent).

You can use bite registration silicone, Panadent bite tabs, wax, or VPS heavy body impression material to capture the record …

I’ll continue this review of the Dento-Facial Analyzer technique in Part 2, coming soon! And don’t miss one of my recent Pankey Gram favorites from Dr. Bill Gregg on an occlusion-focused hygiene exam. Read it here for his insightful tips.

For an in-person, hands-on lesson in the Dento-Facial Analyzer, check out our Essentials 1 Pankey course. You can also watch this video for a quick refresher.  

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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QuickSplint for Diagnostics and Restorative Applications

August 29, 2018 Pankey Gram

QuickSplint has many functions in general practice, but it is also a great resource overall in both diagnostics and restorative dentistry. It’s ideal for patients who grind, those with endodontic issues, and anyone needing a restoration.

QuickSplint to Improve the Patient Experience

Many dentists see patients who have wear on their teeth but don’t think they grind at all. They might have said that they used to grind their teeth, but they believe they don’t anymore. You can use the QuickSplint as a learning experience where the patient is able to recognize the cause of the attrition.

It’s nice to rely on this quick, easy, and inexpensive device. Go ahead and have the patient sleep in it for a little while. The QuickSplint will then reveal whether or not they are clenching and grinding. After the proof is clearly demonstrated, you can have an impactful conversation with your patient.

Another option for QuickSplint use is as a means for handling parafunction and restorative materials selection. Today, we talk a lot about posterior materials when we are doing crowns on first or second molars. Are we going to use high strength ceramics or traditional PFM restorations? Instead of guessing about the patient’s parafunctional risk and how much load they will place on the restoration, you can easily get that information with a QuickSplint.

Additionally, you can use the QuickSplint as a post-op device after an endodontic procedure. You can reduce a patient’s discomfort significantly in less than three minutes and also help the tooth heal without occlusal pressure. You then won’t have to take the entire occlusal table off the problem tooth. This can even work during pre-op for a patient whose tooth appears to need endodontic treatment.

In our Essentials One course at Pankey we use the Quicksplint as an overnight deprogrammer to allow us to capture very accurate diagnostic records.

Do you use QuickSplint in your dental practice? Tell us your best tips for using this handy little tool!

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Splint Therapy: Time Is on Our Side Part 1

August 3, 2018 Will Kelly DMD

My experience with splint therapy was like most dentist’s prior to developing the skills taught at Pankey. In fact, my appliance was not really therapy at all. Perhaps just a shot in the dark “helmet” that protected teeth against collisions with very little intention.

Throughout the years there have been many facets of my experience I value greatly in guiding patients to health using plastic:

Splint Therapy and Appliance Design

Appliance design is a provisional analog (that is, a practice replacement) for any changes we make to the teeth and ultimately the stomatognathic system. The splint is a great diagnostic tool that is capable of healing, but it’s also an iconic part of the behavioral interaction between the provider and the patient.

Aside from physically being an orthotic analog, the splint is a training tool, maybe even the greatest reversible “do-no-harm” in our profession. Case by case, each patient experiences changes and familiarizes themselves with my touch and caring.

Month by month and year by year dentists educate themselves and develop an understanding of bite relationships by using therapy. This happens case by case too, much like waxing cars and painting fences for Mr. Miyagi. As the experiences compile, sometimes our questions do as well. Sometimes we turn to our mentors for answers, much like the Karate Kid.

For the learning dentist, different parts come together when bringing splint therapy from the classroom to the operatory. There is the initial understanding of the “why” that can be conceptualized in theory, but not realized in practice until the “how” of the technical piece arrives through experiential understanding.

Each provider comes into their own by developing skills to have patients relate needs and eventually invite them confidently to enter appliance therapy.

There’s more to come in Part 2! What challenges have you faced in splint therapy techniques to ease patient discomfort? 

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Will Kelly DMD

Dr. Will Kelly attended the North Carolina State University School of Design and received a BA in Communications. He went on to spend two additional years in post baccalaureate studies in Medical Sciences at both UNC Chapel Hill and Virginia Commonwealth University. Dr. Kelly graduated from the top ranked UNC School of Dentistry in 2004. His good hands and clinical abilities led to his being chosen as a teaching assistant to underclassmen in operative dentistry. In addition to clinical time in the dental school, Dr. Kelly had valuable experiences working in both the Durham VA Hospital and for the Indian Health Service in Wyoming. As a child, Dr. Kelly had the opportunity to assist his father on several dental mission trips in Haiti. After completing dental school, Dr. Kelly joined his father in private practice and served on the dental staff at Gaston Family Health Services, where he maintained a position on the board of directors. At this time Dr. Kelly also began his studies in advanced dentistry at the prestigious Pankey Institute in Miami, a continuing journey of learning that has shaped his philosophy and knowledge of the complexities of high-level dentistry. Today Dr. Kelly devotes over 100 hours a year studying with colleagues and mentors who are regarded as "Masters of Dentistry".

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Fixing the Failed Restoration: Provisional and Placement

August 1, 2018 Lee Ann Brady DMD

My patient wasn’t satisfied with the esthetics and feel of her previous restoration. Detailed planning enabled me to deliver a beautiful, functional result. Here is the conclusion of this case and placement of the new six unit anterior bridge:

Failed Restoration: Provisional

After the treatment planning was completed, I removed the patient’s existing anterior bridge and replaced it with a bisacryl provisional derived from the orthodontic wax-up. I sectioned it specifically to enable tooth movement while I restored the pontic sites. This meant sectioning between the maxillary central, the upper left lateral and central, and the upper right canine and lateral.

I then cemented the provisional with Rely-X luting cement. Doing so decreased displacement secondary to the orthodontic forces. Next, the patient went through orthodontic therapy over three months. Following this, she was ready for periodontal surgery. Crown lengthening was done on the upper right canine, in addition to placing connective tissue grafts in the pontic sites. This ensured ovate pontics could develop.

Failed Restoration: Equilibration & Placement

Equilibration was the natural next step. It was used to achieve the necessary anterior guidance with posterior disclusion, as well as freedom in the anterior and no centric occlusion slide to maximum intercuspal position.

I prepped off the orthodontic provisional and refined the preparation. For the margin design, I went with a shoulder and rounded internal line. This could accommodate the all-porcelain restorations.

We weren’t worried about the reduction of 1.5 mm because of the original tooth reduction, but we did go forward with placement of a third plane of reduction. This was necessary for final incisal edge placement in a AP dimension.

Venus from Hereaus was used to create the six unit provisional from upper right to upper left canine. This also allowed tissue development to occur in the pontic sites.

After taking final impressions three months later, the six unit bridge was made using E.max. I placed the patient’s direct composite veneers on the upper first molars and bicuspids. Shade matching to the anterior bridge was one advantage of this approach. Also, the patient could choose to move to porcelain at some point in the future.

My patient was finally happy with her smile. All in all, it took dedicated teamwork between myself, the ceramist, orthodontist, and periodontist to exceed her expectations. 

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Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

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About Author

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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