The Transition to Digital Dentistry Part 2

January 17, 2024 John Cranham, DDS

When my daughter Kaitlyn (currently in through E2 at Pankey) finished dental school in 2020, I strongly recommended that she learn analog first, then once mastered, make the transition to digital. This lasted about four months. I learned rapidly that this generation sees things in the digital realm far better than we do. She reminded me that “she grew up with a screen in her hand.” 

We began to focus on her learning the concepts of occlusion, esthetics, biology, tooth-by-tooth structural integrity, and visualizing and planning in the virtual (digital world). We quickly learned that, although she could easily visualize things on the computer, the patient is ultimately analog. We began to utilize an analog articulator for her to learn the hand skills of what we would do on the patient. 

A great example of this is equilibration. A “trial equilibration” on a virtual articulator is a 5-minute process that lets us determine if equilibration is an appropriate treatment option. The problem is that, unlike analog, you do not learn the brush strokes that will be required to perform this skill in the mouth. I have performed hundreds if not thousands of equilibrations. I know the brush strokes. For me, once I see on the virtual articulator that I can do the equilibration without too much tooth structure removal, I am ready to go to the mouth. For Kaitlyn, who has very limited equilibration experience, once visualized on the virtual articulator, then it’s time to go back to analog. She mounts the printed models on an analog articulator to perform a traditional trial equilibration. In this way, she learns the brushstrokes of this incredibly important procedure. 

I think it is extremely important that dentists, who are learning to equilibrate intraorally, work on mounted analog models to develop their equilibration skills. 

Returning to the consideration of the financial cost of bringing new technology into your practice—input devices (scanners and CBCTs), output devices (printers and mills), and software to manipulate the data all cost money. Doctors that are going down this road usually like technology and consider the dramatic increases in efficiency to ultimately increase the productivity and profitability of the practice. This is certainly something I have seen. The bottom line is dental stone will go away. We all must make the decision when it is appropriate to make the jump. 

Dr. Lee Ann Brady has invited me to audit all the Pankey Essentials courses over the next year. I am super excited about this. She has asked me to recommend ways to appropriately implement examples of digital technologies and workflows into these core classes. While younger dentists are drawn to digital information, it is important for us to remind them that our patients are ANALOG. We are training dentists to perform complex procedures on patients, not on computers. This requires great study and a commitment to understand timeless concepts, while simultaneously developing the hand skills to accomplish these procedures accurately and use digital workflows to make things more efficient. 

In 2024, The Pankey Institute is also implementing a digital hands-on course for those doctors who would like to make the transition over to virtual articulation and digital workflows—something that I am excited to be part of. Dentistry is in a great transition. I look forward to making sure the concepts that we have all built our practices around do not get lost in the digital world. 

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John Cranham, DDS

Dr. John Cranham practices in Chesapeake, Virginia focusing on esthetic dentistry, implant dentistry, occlusal reconstruction, TMJ/Facial Pain and solving complex problems with an interdisciplinary focus. He practices with his daughter Kaitlyn, who finished dental school in 2020. He is an honors graduate of The Medical College of Virginia in 1988. He served the school as a part time clinical instructor from 1991-1998 earning the student given part time faculty of the year twice during his stint at the university. After studying form the greats in occlusion (Pete Dawson & The Pankey Institute) and Cosmetic Dentistry (Nash, Dickerson, Hornbrook, Rosental, Spear, Kois) during the 1990’s, Dr. Cranham created a lecture in 1997 called The Cosmetic Occlusal Connection. This one day lecture kept him very busy presenting his workflows on these seemingly diametrically opposed ideas. In 2001 he created Cranham Dental Seminars which provided, both lecture, and intensive hands on opportunities to learn. In 2004 he began lecturing at the The Dawson Academy with his mentor Pete Dawson, which led to the merging of Cranham Dental Seminars with The Dawson Academy in 2007. He became a 1/3 partner and its acting Clinical Director and that held that position until September of 2020. His responsibilities included the standardization of the content & faculty within The Academy, teaching the Lecture Classes all over the world, overseeing the core curriculum, as well as constantly evolving the curriculum to stay up to pace with the ever evolving world of Dentistry. During his 25 years as an educator, he became one of the most sought after speakers in dentistry. To date he has presented over 1650 full days of continuing education all over the world. Today he has partnered with Lee Culp CDT, and their focus is on integrating sound occlusal, esthetic, and sound restorative principles into efficient digital workflows, and ultimately coaching doctors on how to integrate them into their practices. He does this under the new umbrella Cranham Culp Digital Dental. Dr. Cranham has published numerous articles on restorative dentistry and in 2018 released a book The Complete Dentist he co-authored with Pete Dawson. In 2011 He along with Dr. Drew Cobb created The Dawson Diagnostic Wizard treatment planning software that today it is known as the Smile Wizard. Additionally, He has served as a key opinion leader and on advisory boards with numerous dental companies. In 2020 he published a book entitled “The Cornell Effect-A Families Journey Toward Happiness, Fulfillment and Peace”. It is an up from the ashes story about his adopted son, who overcame incredible odds, and ultimately inspired the entire family to be better. In November of 2021 it climbed to #5 on the Amazon best seller list in its category. Of all the things he has done, he believes getting this story down on paper is having the greatest impact.

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Start the New Year with an Annual Fee Evaluation

January 15, 2024 Lee Ann Brady DMD

One of the things that I take the opportunity to do every year in January is evaluate my fees. I am disciplined about this because the cost of doing business goes up every year.  

Whether it is a low inflationary time when the cost of doing business has gone up 1-1.5%, or it is more like the recent period when the cost of doing business has gone up 7-10%, our profitability is going to decrease if we don’t adjust our fees. When profitability decreases, usually the dentist’s compensation decreases.  

The Fee-by-Fee Way 

We can go through our fee schedule, fee by fee, and raise them individually. Dentists who do this are concerned that they will lose patients if they raise certain fees, for example, their fees for regular recall exams and dental cleanings. Dentists who take the fee-by-fee approach tend to believe patients are less price sensitive to the cost of restorative dentistry and appliances. Some dentists cover the increasing costs of Hygiene by increasing the fees for their restorative procedures. 

The Global Way 

Alternatively, we can do a global fee increase that raises every fee by the same percentage. This is my preferred way. To select the rate, I will look at my 2023 end-of-year profit and loss statement (from my accountant) and compare it to my 2022 end-of-year profit and loss statement. Did I make a profit in 2023? Was it higher or lower than in 2022? I don’t want to make less profit year to year.  

I will also look hard at my practice’s operating expenses in 2023 compared to 2022. I expect 2023 will be significantly higher because we have gone through high inflation in 2023 that none of us could have reliably predicted at the end of 2022.  

For example, if overhead was 65% in 2022 and jumped to 68% in 2023, I must increase my fees by at least 3%, plus a percentage I anticipate will cover overhead increases in 2024. If my profitability decreased in 2023, I also would want to compensate for that loss in the future. (Our “healthy business” goal each year is to maintain and hopefully increase profitability.) 

To arrive at the final percentage that I will raise my fees across the board, I will factor in the raises I want to give my team and myself in 2024, and the other expenses I know (or anticipate) will go up.  

The Global Way Is Easier 

If we do piecemeal fee increases, it becomes a complicated set of mathematics to determine if we will recapture last year’s decrease in profitability, cover next year’s increase in overhead, and hopefully increase our profitability over the next year. If you want to be cautious, you can blend the two approaches. Do a global increase and then go back and look at the price-sensitive fees you are concerned about and lower just those. This is the Modified Global approach. 

Evaluate Your Fees Early in 2024 

Annual evaluation of our fee is a must-do, and I don’t think there has ever been a better time to raise fees in all the years I have practiced. We live in a time when everything costs more. Patients understand that our overhead costs have increased. They know we are running a business and want us to stay in business to be there for them. 

I encourage you to use a system of thinking to figure out which fees you will raise and how much you will raise them. I advocate for the global approach or the modified global approach. Ask your accountant to give you profit and loss statements for 2022 and 2023. If you need help with your evaluation, ask your accountant or practice management consultant to assist you. 

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Mastering Business Essentials

DATE: August 7 2025 @ 8:00 am - August 15 2025 @ 12:00 pm

Location: The Pankey Institute

CE HOURS: 22

Regular Tuition: $ 3295

Single Bed with Ensuite Bath: $ 345

The Blueprint for Running a Practice with Long-Term Growth Dr. Pankey’s original philosophy encouraged dental professionals to be proficient in 3 specific areas: technical mastery, behavioral excellence and business savvy….

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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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Your Commitment to Profitability

October 21, 2019 Drs. Christina & Bill Blatchford

Dental graduates frequently say they chose dentistry because they liked science and working with their hands. Many thought medicine was their path, but in medicine, they saw the lack of control and time away from family. Dental graduates also say they were attracted to dentistry due to the monetary return they could get for their efforts.

When practicing, profitability can be elusive. You can feel like your child’s hamster trying to outrun your overhead. You can feel like dentistry is #1 in your life and there really is no other life for you, but you are frustrated because your dream was to be farther along in your debt reduction and wealth growing. You are putting in the hours but not receiving the return.

Many things and decisions can get in the way of profits.

We want to convey positivity here, not rehash the problems. You can have a profitable practice. A larger net return can be yours.

Let’s have a frank discussion about you, the leader, THE one who wants very much to win in the game of profitability. The keys to profitability involve YOU–your attitude, your team’s attitude which comes from you, and systems you need in place to be more efficient.

YOU are the key to opening the profitability gate. What is your current attitude about life, your success, and your situation? This is a challenge as you are slightly prejudiced. Do you have a family member or a really good friend who can assess your attitude (your positivity about yourself)? Years of negativity can be a challenge.

How do you feel about the future?

Here are some questions to help assess your present attitude about yourself:

  • What are your goals five years from now?
  • What are you looking forward to?
  • What do you want most out of life?
  • What do you like best about yourself?
  • What do you feel motivates you?
  • Do you have any personal power in your life?

At Blatchford Solutions, when we work with dentists and teams, we ask them to assess various life choices, such as the place they choose to live, and the friends, marriage partners, courses and schools they choose, even cars, vacations, restaurants and more. We all have a Comfort Zone for each of these areas and when pushed out of your comfort zone, you reply, “I would never go there, do that, try that, spend time on that”, and more. Our comfort zones have a floor and a ceiling.

You need to know if your “Deserve Level” allows you to be profitable. You can sabotage your success if you feel you deserve less. You can modify your Comfort Zone (Deserve Level) with a clear vision, strong determination and possibly some outside help.

What is profitability to you?

Put some numbers down; spell it out for yourself at this time. Is a net of $500K unreasonable for you? Do you deserve to have 60% overhead on $1.2M collection? Is a net of $750K unreasonable for you? Is a net of $1M something you deserve? Do you deserve to be debt-free? What would change in your life if you were debt-free?

Your Deserve Level also affects the quality of team members with whom you choose to work, the building and area in which you choose to practice, the continuing education courses you take, and so many non-dental activities, too. Our goal is to help you realize you can be as profitable as you feel you deserve. Dentistry is not just about your clinical excellence. It can also be about your excellence in the business of profitability.

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Enhance Restorative Outcomes The main goal of this course is to provide, indications and protocols to diagnose and treat severe worn dentition through a new no prep approach increasing the…

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Drs. Christina & Bill Blatchford

Dr. Christina Blatchford is a graduate of Oregon Health Sciences University, School of Dentistry and has her doctorate degree in medical dentistry. She practices family and general dentistry in Milwaukee, OR. With her father, Dr. Bill Blatchford, she is Co-CEO of Blatchford Solutions, coaching a maximum of 50 dentists each year to reach their goals. Bill has written two books: Playing You ‘A’ Game – Inspirational Coaching to Profitability and Blatchford Blueprints: The Art of Creating Dental Practice Success. He also writes a monthly column for Dental Economics, “Flourishing in Changing Times.” You may call 888-977-4600 to receive a free copy of their latest book, Seven Principles of Highly Profitable Dentists.

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