goetze advantage. - Writing, editing, communications consulting

dv nt ge 2007
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Equipping high performance practices
timeless dentistry
Dental practice employs
tried-and-true methods
making an upgrade
Incorporating new technology
successfully into your practice
blueprint for
success
Designing innovative
office spaces
step by step
Budgeting for new equipment
PREFERENCE
THE
Access and Comfort
The new A-dec 500™ chair is specifically designed to optimize
access and maximize comfort. So for the first time, you can have a
chair that makes no compromises between patient and practice.
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I C C™
4
PHASE STERILIZATION SYSTEM
Ultra-thin, flexible backrest
Unique, slim-profile gliding headrest
Comfortable, pressure-mapped upholstery
Smooth and quiet chair motion
Rotating, multi-position armrests
Seamless or sewn upholstery
Efficient Sterilization
Preference ICC is more than just a “center.” It’s a complete system designed to
closely follow the phases of sterilization as recommended by the Centers for
Disease Control (CDC). As a result, related steps are grouped together, simplifying
and streamlining the entire process. Preference ICC also offers a large selection of
modules, options, and colors. So whether you’re looking for a small make-ready
cabinet or a complete, centralized sterilization room, you can create an efficient,
streamlined system that’s specifically made to integrate with your practice.
• Process-based design for a consistent, intuitive sterilization
protocol and simplified training
• 17 Standard laminate and 16 solid surface countertop choices to
match existing Preference® cabinetry or your existing color scheme
• Heavy-duty hardware and surfaces to maximize long-term value
• Hands-free drawers, doors, faucet, and a motion-activated soap
dispenser to minimize risk of cross contamination
www.a-dec.com
For more information on the A-dec 500 product line, contact your
[dealer name] representative today.
For more information on Preference ICC, contact your
[dealer name] representative today.
Dealer
Special
or800.692.0804
Other Reference
Goetze
Dental
Dealer
Special
or 800.692.0804
Other Reference
Goetze
Dental
©2004 A-dec Inc. All rights reserved.
www.a-dec.com
©2006 A-decTM Inc. All rights reserved.
Dynamic
Duo
I n t r o d u c i n g A-DEC 500.
Synergizing Ergonomics.
TM
Unique track-mount for
maximum flexibility in
Cut precise preps more powerfully than a locomotive.
monitor positioning
Finish restorations faster than a speeding bullet. And
perform endo in a single bound. Sounds far-fetched.
Yet with two incredibly dynamic electric motors completely
integrated into the delivery system, you can now feel
more like a superhero. And it’s only possible with A-dec.
To find out more, contact your local A-dec dealer,
visit www.a-dec.com, or call 1.800.547.1883 today.
Sturdy, round worksurface
with enough room to hold
precisely what you need
A-DEC 500
Productivity
at 12 O’Clock
®
Worksurface and instrument
holders that rotate and pivot for
practically unlimited positioning
Better positioning is paramount to productive
dentistry, no matter what delivery style you
choose. Which is why we created A-dec 500 at
12 o’clock. In addition to a round, rotating, and
height-adjustable worksurface, A-dec 500 features
pivoting instrument holders that position virtually
anywhere around the worksurface—which means
better visibility, less stretching, and reduced motion
A-dec 532 delivery system with
deluxe touchpad and two factory-installed
A-dec/W&H EA-51LT electric motors
www.a-dec.com
Goetze Dental
800.692.0804
www.goetzedental.com
For more on A-dec 500,
for you and your assistant. Add the ability to
contact your authorized
seamlessly integrate electric motors, intraoral
A-dec dealer, visit
cameras, as well as other small equipment, and
a-dec.com,
or call
contact Goetze
Dental, or
you have a completely flexible system that offers
1-800-547-1883
today.
call 800.692.0804
today.
better ergonomics and efficiency than any other
For more on A-dec 500,
12 o’clock delivery solution available today.
©2006 A-dec® Inc.
All rights reserved.
©2005 A-dec Inc.
All rights reserved.
www.a-dec.com
Welcome to the Goetze
Follow the Leader...
Advantage.
When you love what you do, you’re always looking to do
it better. It could be improving your skills, following trends, applying new technology equipment or implementing new services.
That’s how we feel about our business — and yours, and it’s
exactly our vision for Goetze Advantage: Equipping High
Performance Practices.
Indeed, education fits perfectly in Goetze Dental’s mission, and
Goetze Advantage intends to live up to that mission in new ways.
We hope your entire office will take away new information, learn
about other successful practices and offer ideas you can put into
action immediately.
Long-time customers of Goetze Dental know they can count on us
to understand their goals. We pay attention so we can deliver
products and services exactly the way you want. If we’re just
starting to work together, we hope you’re experiencing the same
win-win relationships we work hard to establish and maintain.
For us to truly be a different kind of dental supplier, we must do
far more than deliver equipment and replenish supplies. We must
serve your entire office, doing everything we can to help you make
your practice everything you want it to be.
From the Leader in Diode Lasers, introducing the Odyssey Navigator
the world’s first truly portable soft tissue laser.
®
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Ergonomic handpiece features an arc design to rest comfortably in your hand
Pre-cleaved, procedure-specific unidose tips makes preparation fast and easy
Battery operated for ultimate portability in the operatory
Intuitive touch screen design for easy activation
Over 30 pre-set clinical procedures installed
Wireless foot control
810 nm wavelength - The Proven Diode Technology
™
O
D
Y
S
S
E
Y®
Navigator
3 W AT T D I O D E L A S E R
TM
Founded on core principles of Integrity,
Customer Service, Excellence and Innovation,
Goetze Dental continues its proud heritage
of being a leader in shaping the direction of the
dental supply industry. Goetze Dental focuses
on the Midwest region. Goetze Dental’s
corporate headquarters is a 45,000-squarefoot distribution facility centrally located in
Kansas City, Missouri.
800.692.0804
www.goetzedental.com
We’ll be listening closely for topics and trends you want to read
about, information you want to learn and people you want to meet.
Consider this an open invitation to tell us what’s on your mind so
we can deliver a Goetze Advantage that gives you the advantages
you want.
Enjoy this brand new Goetze Advantage!
Don Brunker
Owner
Goetze Dental
100% CUSTOMER SATISFACTION
GUARANTEED!
www.ivoclarvivadent.us
Call
toll free atDental
1-800-533-6825
in the U.S., or 1-800-263-8182 in Canada
callusGoetze
at 800.692.0804
© 2007 Ivoclar Vivadent, Inc. Odyssey and Navigator are trademarks of Ivoclar Vivadent.
Goetze Dental 2007
|
Shift
into
high
gear
Contents
27
KaVo
ELECTROtorque
44
· (ET TLC) Torque control and auto reverse electric
motor for endo procedures
· Smooth & concentric cutting for faster,
high quality preparations
· Quieter, improved patient experience
· Best in class warranty and quality that you
expect from KaVo
20
KaVo GENTLEpower Handpiece Attachments
08 Goetze Staff
Meet the Goetze Dental Equipment Team.
· Shortest head with bur inserted
· Quiet and vibration free
· Unsurpassed intra-oral access
10 Growing a new practice
The management side of the dental discipline.
16 Budgeting for new equipment
Effective planning strategies for building a budget.
20 By Design
Stylish looks and a warm welcome in a new office space.
ELECTROtorque TLC
ELECTROtorque plus
Put the ultimate dental experience in your hands today!
Call 1-888-ASK-KAVO
or visit
www.kavousa.com
for complete
Call Goetze Dental
at 800.692.0804
for more
details! details.
27 Spotlight: technology
28 Embracing new technology
Adding high-tech equipment to your practice.
30 Demystifying cone beam 3-D imaging
One scan gives the big picture.
36 Lasers in Dentistry
New techniques and philosophies benefit patients.
42 Using tax dollars to aid your equipment purchase
Benefits of knowing how taxes impact your practice purchases.
44 Arias and Archaeology
Life outside the office.
©2007 KaVo Dental Corporation
Goetze Dental 2007
|
expert® DC
goetze staff
NEW from Gendex!
Goetze Dental is a proud team of dedicated dental professionals committed to
Gary Lewis
32 years | Vice President Equipment
Dennis Thome
23 years | Wichita Equipment Specialist
Brett Drea
10 years | Des Moines Equipment Specialist
Mike McKim
31 years | Kansas City Equipment Specialist
Dave Dougherty
31 years | Omaha Equipment Specialist
Matt Gross
3 years | Kansas City Equipment Specialist
Dennis Dalton
32 years | St. Louis Equipment Specialist
Jay McConnell
18 years | Denver Equipment Specialist
Chris Wilhoit
34 years | Springfield Equipment Specialist
Inga Paul
10 years | Senior Interior Designer
©2007 Gendex Dental Systems, 906.8527/05.07Rev0
delivery of excellence in service to our many valued dental customers.
All Goetze Dental locations are fully staffed by factory trained service technicians. Goetze Dental radio-dispatched service vans are fully stocked with a complete parts inventory to facilitate quick repair
of your malfunctioning equipment.
Goetze Technology
Bryan Creason
Director Technology Division
Troy Bearden
Technical Sales Representative
Monica Schafer
Software Trainer
Ben Poese
Technology Inventory Specialist
|
Goetze Advantage
Kansas City Integrations Technicians
Trevor Kelley
John McCarter
Bobby Wrisinger
St. Louis Integration Technicians
Nick Nichols
Jim Mayer
Goetze Dental Integration
Technicians have the following
technical qualifications:
Microsoft Certified System
Engineers (MSCE)
Microsoft Certified Professionals
Server 2003 Certification
A+ Certification
Network + Certification
Springfield Integration Technician
Michael Bennett
The Next Generation Intraoral X-ray
System Has Arrived!
Omaha Integration Technician
Bryan Smith
Denver Integration Technician
Mike Phillips
Attended the following
factory and software integration training programs:
Air Techniques
Gendex
peb
Planmeca
Sirona
Gendex expert DC combines
the legacy of dependability with
the latest advances in electronic
technology.
This new direct current powerhouse
delivers strong benefits for your
practice: shorter exposures, reduced
radiation, and truly consistent image
quality. Its industry-leading focal
spot of 0.4 mm creates significantly
sharper images than other intraorals,
regardless if you operate with digital
sensors, PSP, or film.
Panoramic X-ray Systems
. Intraoral X-ray Systems
Digital Intraoral Sensors
Digital X-ray Phosphor Plates
Intraoral Cameras
Imaging Software
Leading technology and daily
dependability — the legendary
Gendex reputation continues with
the expert DC.
Gendex Dental Systems
www.goetzedental.com
www.gendex.com
Goetze
Dental 1-888-275-5286
800.692.0804
Call
toll-free:
Imaging Excellence Since 1893
growing
It’s a long way
from the courtroom
to the dentist’s office.
But it’s the path chosen by Ric Crowder, jd and dds. He graduated from
dental school a little more than a year ago and opened a practice in Lenexa,
Kansas. A former medical malpractice defense attorney, he found himself
increasingly drawn to a very different health care career: family dentistry.
“It’s in my blood,” he says. His dad
is an orthodontist, his grandfather a
general practice dentist. “I want to feel
passionate about my work. Helping
people and building relationships with
them is very important to me. I not
only grew up around dentists, I saw
successful businesses, too.”
A year into his new career, Dr.
Crowder makes business decisions
based on the kind of practice he wants
to build: “Timeless Dentistry for All
Generations.” A thoughtful list of
values reflects the role of technology in
oral health, his intention to make the
experience as comfortable as possible
and his desire to act globally,
a new practice
Dr Ric Crowder’s mission and values provide the
foundation for his business operations.
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Goetze Advantage
Managing money,
fees and insurance
Every dentist knows start-up costs can
be staggering. In addition to managing debt, Dr. Crowder experiences
learning curves, such as managing
cash flow. It can be several weeks from
treatment to insurance reimbursements. His perspective balances
short-term cash flow with long-term
profitability as they build a base of
loyal, satisfied and healthy patients.
The practice doesn’t have a hygienist
on staff right now, so he performs that
task. “I get to spend lots of time with
my patients,” he says. “It’s a great way
to establish initial relationships. As
apart is our focus. We focus on our
patients even before we meet them.
I try to call every new patient before
they ever come into the office,” he says.
Every question he asks himself regarding building the business is directly
related to the impact the decision will
have on patient relationships.
Managing cash flow and building a
patient base involves cost/benefit decisions about insurance. “I had to decide
early on whether to grow my practice
primarily by volume or through
repeat business and referrals,” says
Dr. Crowder. He researched options,
looking for insurance reimbursement
rates closer to his fees and demograph-
“I try to call every new patient before
they ever come into the office.”
supporting dental mission and
outreach efforts.
His focus is linking mission and values
to business decisions that ultimately
will help Dr. Crowder run his practice
in ways that will “provide a remarkable
dental experience.”
the practice grows, it will make sense
to hire a hygienist so I can do other
higher-fee procedures and maintain
patient relationships.”
He’ll make decisions about staffing that
relate both to patient care and to
profitability. “One thing that sets us
ics that matched his market. He talked
with other dentists, looking for best
practices and mistakes to avoid. “You
don’t know what you don’t know,”
he says.
Ultimately, he knew he would rather
see fewer patients over the short term
Goetze Dental 2007
|
11
than sign up with multiple plans
simply to attract higher numbers of
patients through the door right away.
He decided to adopt an approach of
providing individualized care and
building the kind of relationships that
build loyalty and encourage referrals to
new patients.
He acknowledges that this strategy
may not always be the fastest way to fill
an appointment book at first, but he is
confident it’s the right approach for his
Relaxed but
professional atmosphere
Creating the right atmosphere has
been another important opportunity to
link business decisions to patient care.
Overall, he wanted to create an office
that is relaxed but professional. Recognizing that most people don’t relish a
visit to the dentist, Dr. Crowder made
an investment in specialized one-onone training in customer service and a
welcoming office space with the right
mix of technology.
build his practice over the long term.
“This technology reduces radiation
exposure required to diagnose dental
pathologies,” he says. Similarly, he
does not purchase technology for
technology’s sake or, as he puts it, to
“show off.” He truly means it when he
talks about “timeless dentistry,” noting
that some 50-year-old treatments are
just as viable today.
For example there are times an amalgam filling or gold crown is the best
I look for equipment that makes
people physically more comfortable,
speeds up the process or saves them from
hearing the drill or other noise.
practice long term. He decided to sign
on as a preferred provider with just
two insurance carriers that match his
business approach.
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Goetze Advantage
For Dr. Crowder, the decision to
purchase digital radiography equipment rather than traditional dental
x-ray equipment reflects his desire to
treatment option. This tried and true
material may, at times, be better for
the patient than the latest nano-hybrid
composite resin or porcelain crown.
“I selected equipment and technology
with the patient in mind,” he says. “I
look for equipment that makes people
physically more comfortable, speeds
up the process or saves them from
hearing the drill or other noise.” For
example, there are tv monitors in the
patient’s line of sight. From Oprah or
cnn, to the Food Network or espn,
every patient can find something
to watch.
floor space in terms of what would
physically fit the space. I’m a ‘book
There are decisions about equipment,
and there are decisions about the lookand-feel of the office, too. It’s all part
of the package when patients come to
the dentist’s office. “Goetze was a huge
help,” says Dr. Crowder. And not just
deciding what equipment to install and
supplies to stock. “Inga did the design
and worked with Mike to analyze the
guy’ — I like how-to information.
They provided a start-up checklist
and even steered me away from
some purchases.”
In addition to the specialized dentrix
package, they also use QuickBooks® for
“One of our biggest
lifesavers has been
going paperless.”
Operations
and management
The team at Crowder Family Dentistry
also includes administrative staff
Kristie and Holly. “We are fortunate to
have these two great people,” he says.
They care about growing this practice
in ways that match the mission
and values.
The Web and software tools are essential tools for the office’s day-to-day
operations and financial management.
“One of the biggest lifesavers has been
going paperless,” Dr. Crowder says.
“We don’t keep any paper in the office.”
Patients save time, too, by filling out
paperwork and submitting appointment requests online.
The office also uses a practice management system from dentrix®. It
supports scheduling, accounting tasks
(including billing, payment plans), and
automatic claim filing. They save time
because tasks are built into a single
system and the software generates
reports to track marketing efforts and
practice stats.
bookkeeping. It maintains their books,
generates various financial reports and
reminds them to file tax reports.
Right now, Dr. Crowder says traditional measurements and financial
statements aren’t influencing management practices much. “As we grow,
profit and loss statements will become
more important, and we’ve put the
systems in place.”
Acknowledging that his legal
background may have helped with
initial negotiations and contracts, Dr.
Crowder quickly and enthusiastically
credits the business savvy of another
doctor in the family: his wife, Susan
Crowder, dvm. “She has business
experience and insights that I simply
don’t have. She encourages me to look
at long-term business growth.”
Overall financial goals include reducing debt load and, of course, bringing
home a nicer paycheck.
“We’ll just keep learning, looking at
how we adjust our fees, our scheduling
tasks, and how we keep our energy
up for the long-term so our business
success is not dependent on insurance
but on delivering outstanding care to
loyal, satisfied patients.”
Goetze Dental 2007
|
13
www.goetzedental.com
www.goetzedental.com
STEP3
DETERMINE THE NEW PRODUCTION GOAL
You are now ready to determine your new projected
12-month production goal. Before you do this, you must
decide on a realistic collection percentage goal. You
should assume you will collect 98 percent of your production. This is a goal you should expect to achieve.
STEP4
DETERMINE WORK DAYS
Now determine how many days you will work during the
year. Consider holidays, vacations, continuing education
and flex/bonus days. Determine doctor days as well as
hygiene days.
STEP5
ESTABLISH HYGIENE PRODUCTION GOALS
Hygiene production goals are determined prior to the
doctor’s goals because the hygiene production mix and
number of patients seen per day are more predictable.
written by
debbie castagna & virginia moore
Need new equipment but can’t seem to fit it in the budget? It’s a common
dilemma. If your practice needs new equipment but the money isn’t
there at the time you need it, you need to budget. Here are seven easy
steps to help you understand your financial picture.
STEP1
ANALYZE YOUR PROFIT & LOSS STATEMENT
In order to successfully control overhead and work within
a budget, you must first have an accurate assessment of
what overhead includes. It includes business expenses. It
does not include personal expenses. Personal expenses are
considered part of doctor compensation. Actual overhead
is determined by comparing business expenses (i.e., overhead) to what you produce, not what you collect.
Once you have determined your actual expenses, calculate
your overhead percentage by dividing expenses into pro-
16
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Goetze Advantage
duction. In general, your overhead should fall within the 45
percent to 65 percent range to be considered healthy.
STEP2
FORECAST THE COMING YEAR’S EXPENSES
Armed with your current overhead, you are now ready to
forecast expenses for the coming 12 months. Categorize
each expense as fixed or variable. Fixed expenses remain
the same regardless of production (i.e., rent or medical
premiums). New equipment is a fixed expense – budget for
it. Variable expenses fluctuate according to production (i.e.,
lab and dental supplies).
To begin this calculation: determine the hygiene daily
(or hourly) production average for the last 12 months. In
this example, we are using $900 per day as our 12-month
average. Use this number to determine reasonable average monthly and yearly hygiene production goals for the
coming year.
Using $900 per day as your goal for the coming 12
months, create a realistic day in the hygiene department to help you achieve that goal. Include all common
procedures: prophys, scaling and root planing, perio
maintenance, fluoride, periodic exams, bxw, fmx/Pano,
retail products, sealants. Estimate the average number of
procedures per day for each category and assign a daily
value to each. List other procedures individually, then
total month-by-month and for the year.
STEP6
DOCTOR PRODUCTION FORECAST WORKSHEET
You are now ready to determine the doctor production
goal, using this formula:
• total office production goal: (from Step 3)
• minus total annual hygiene goal (from Step 5)
• equals doctor’s needed production
Review your figure and determine if it is reasonable and
achievable. Begin by determining the doctor’s average
daily production for the last 12 months. If the amount
needed to reach the new daily production goal is not
realistic based on the previous year’s production and any
changes you anticipate for the coming year, consider
the following:
• Decrease expenses
• Raise fees
• Work additional days
STEP7
ACTION PLAN FOR NEXT YEAR
To support the achievement of your goals, create an action
plan worksheet to list and keep track of to-do items. Keep
it simple. Your worksheet only needs to contain the
following information:
• Who?
• What?
• By When?
Use this simple seven-step process and see how easy it can
be to plan your way to success and profitability, and to
finally have the money available to buy those things – like
new equipment – you really want and need.
Debbie Castagna is co-founder of The Practice Source, a
provider of management consulting services as well as
books and e-books. She is president-elect of the Academy
of Dental Management Consultants.
After the hygiene goals are established and the calculation
for the annual hygiene production is complete, subtract
that from the total production needed. That number
is the starting point for determining the doctor’s
production goal.
Virginia Moore is one of the industry’s most experienced
and accomplished consultants, speakers and authors.
She is co-founder of The Practice Source and is a
past president of the prestigious Academy of Dental
Management Consultants.
Goetze Dental 2007
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17
The Next Genera tion of dent al
e qu i p m e n t by D e n t a l E Z ®.
When image is everything,
Sirona digital is picture perfect every time.
Dual Access Work Station
Team Work Station
Assistant’s Work Station
The J/V-Generation® Chair
NEW NextGen™ Carts!
NextGen™ Work Stations by DentalEZ® provide easy access to
everything you need for an efficient and comfortable work station.
The J/V-Generation® Chair, with the exclusive independent seat tilt,
allows for patient control and comfort and provides direct access
to the oral cavity without reaching or twisting.
FREE Ultraleather TM Upgrade with purchase of
J/V-Generation Chair!
®
866-DTE-INFO
www.dentalez.com
Call Goetze Dental at 800.692.0804 for more information.
Welcome to the Sirona digital office.
Treatment Centers
Instruments
Imaging
Your practice’s image is dependent on quality care and a positive patient experience. With Sirona
digital X-ray, you can count on razor sharp images every time for clear, consistent diagnoses. Sirona’s
enhancement features deliver significantly improved diagnostic information when compared with
conventional X-rays, whether you’re using the SIDEXIS IO-2 Intraoral Sensors or the ORTHOPHOS XG
family of panoramic products. Add to that the lower radiation exposure, optimized patient
communication and ease of use of the SIDEXIS imaging software, and you’ll have plenty of reasons to smile.
Sirona digital imaging – Advanced technology that’s easy to use.
www.sirona.com - 800-659-5977
T h 800.692.0804
e
D e| www.goetzedental.com
n t a l
C o
Goetze Dental
m p a n y
by
design
This dentist’s new office integrates
stylish looks and a warm welcome.
Goetze Dental 2007
|
21
Hip.
You could use other words to describe the office of
pediatric dentist Kurt Aarons, DDS — colorful, welcoming, warm, open,
functional, brand-spanking-new — but hip may trump them all.
“I wanted the office to be kid-friendly, but not childish,”
he says. Dr. Aarons’ patients range in age from young
toddlers to older teens.
He achieved that vision. Full of natural light, the reception
area is as stylish as it is comfortable and welcoming. The
palette features warm colors — a sophisticated take on
primary colors — with texture, contemporary artwork,
comfortable seating in the reception area and oversize
windows. Murano glass pendant lights accent the reception desk. Throughout the office, sleek euro-style cabinetry
provides efficient storage.
A large saltwater aquarium bubbles quietly across the
room from the front door, and the kids head straight for
it — “Nemo!”
The entire look is so engaging that “the fish guy” even took
note, stocking the tank with blue tangs, orange-striped
clown fish and others that complement the décor.
Goals and vision
When he bought into a practice as a new dentist several
years ago, Dr. Aarons occupied a 1,600 square-foot space.
Since then the practice outgrew the space and it became
dated. The older building also posed problems of its own.
As he considered a new office, Dr. Aarons had three
primary goals:
Functional layout
Patients’ and parents’ comfort
More space
He realized those goals with the help of a team that
included a commercial realtor-developer (a long-time
friend), an architect (another long-time friend), a contract
furnishings rep — who happens to be his wife, Liz, and
the Goetze Dental team.
Functionally, the new office layout streamlines the way
they work. “Most offices use the same door coming and
going into the clinic area. Our layout is
a loop.” Patients enter the clinical area
on one side of the reception desk. The
four hygienist chairs sit in a handsome,
open, yet private, area. Two operatory
rooms are around the corner, across
the hall from lab and storage space.
Then it’s one swing around the corner
where patients check out on the other
side of the reception desk.
The clinical area is about as comfortable as you could get in a dentist’s
office. The spaces use the same large
windows as the waiting room and
incorporate a more subdued, though
still warm, color scheme. Flat-screen
tvs with dvd players in the operatories help distract young patients.
“I not only needed more space overall,
I wanted more storage. And I didn’t
want to be cramped,” says Dr. Aarons.
The spacious new office includes a
break room with lockers for the sevenperson staff, a consultation room and
Dr. Aarons’ personal office.
The process
While he had a vision for the look and
feel of a new office, getting here wasn’t
so clear-cut. He wanted the same
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Goetze Advantage
Planning a new office or
renovating your existing space?
Based on his recent experience, Dr. Aarons offers
some words of advice.
• Look at other offices with your architect before you
get too far along, and ask questions. They deliberated
over wood floors vs. carpet, discussed colors, studied
layouts and noted what might work (or not) for the
new office.
• Hire an architect and designer who have experience working with dental practices. They understand
details like electrical outlet placement in relation to
equipment. They understand power requirements to
support all the equipment.
• Take a team approach. Make sure you click with your
architect and designer. Involve a realtor or developer
if you are changing locales. Pick the brains of your
staff and consider what they need in terms of space
and amenities.
• Consider everyone in the office: Patients, parents,
staff — even the dentist!
Goetze Dental 2007
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23
Inga and Mike worked closely to make sure
that the space and equipment matched ... and
consulted with Dr. Aarons at every step.
locale, just off Kansas City’s Country Club Plaza, ample,
easy parking and access, more space and the right cost.
Dr. Aarons and his realtor/developer looked at many
different spaces over five years. He considered moving
to existing office buildings, renovating an existing dental
practice and building new. He eventually found a suitable
lot and brought the architect onboard. Soon after, Goetze
Dental joined the team. “I’ve worked with them for years,
so there was no question who would be involved in planning the new office.”
Inga Paul, Goetze’s professional, degreed interior designer, met with Dr. Aarons and the architect. Next, she
designed the space to match Dr. Aaron’s goals and needs.
In addition to laying out the office floor plan, she specified
structural requirements along with the plumbing, power
requirements and electrical details to support radiology
equipment, lighting and the computer network.
Goetze Dental customers can take advantage of these professional office planning and design services at no extra
cost. Bonus: The Goetze team stays with you throughout
the process, from design through construction, equipment
installation and start-up.
Mike McKim, an equipment specialist with Goetze Dental, worked with Dr. Aarons to recommend equipment,
Overall, Goetze’s Brian Lumbard was the point person
who coordinated everything, from equipment sales to
installation, demos and training. He facilitated communication between all the parties and visited the site at
critical milestones. “Goetze was there when the concrete
foundation was poured and the plumbing hook-ups put
in place,” Dr. Aarons recalls. “They were there way before
equipment arrived, even before we broke ground.”
Technology component
His new office presented a timely opportunity to transition from traditional x-ray imaging to digital radiography.
His practice has a long-running relationship with Goetze
for dental equipment and supplies, but the full scope of
the company’s technology services was new to him.
“Goetze completely took care of the technology side,” says
Dr. Aarons. “I was impressed.”
Goetze supplied all hardware and software and supervised
or performed every task related to the office network,
from cat-5 cable installation to training. The system
integration included hardware, software and computers at
all six chairs and elsewhere in the office. They integrated
the software for the new digital radiography equipment
with the patient management system for charts and
scheduling. Goetze also provided staff training on
software and hardware.
Other than one recently-purchased
operatory chair, everything in the
office is brand new.
furnishings and cabinetry and prepare quotes. Other than
one recently-purchased operatory chair, everything in the
office is brand new.
The end product
Far from a linear process, with handoffs from one person
to the next, it was a collaborative process. Inga and Mike
worked closely to make sure that the space and equipment
matched, they coordinated with the architect as necessary
and consulted with Dr. Aarons at every step.
“And I like it, too! I’m here every day, so I need to enjoy
the way my office looks and functions.”
Dr. Aarons looks around, adding a final note of
satisfaction:
The new office is beautiful, comfortable, functional and
spacious. The fish look good, too.
Goetze Dental 2007
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e
bl
la
G
IN !
R
ar
AT EA
Ye
BR TH Y fers he
LE 5 Of ut T
CE R 3 cial ugho
e ro
OU Sp Th
ai
Av
advantage:
Technology
Patients must have cheered novocaine at the turn of the century
as the greatest technological breakthrough in dentistry.
Increase Your
Case Acceptance
with Integrated
Software Solutions
Empowering your staff to do more
with the function of simplicity.
Obviously a lot has changed. Practicing dentistry today
involves many possibilities to incorporate technology.
Scientific progress and r&d bring new techniques and
equipment that use digital and laser technology. On the
business side, many offices are easing out paper in favor
of practice management software that integrates patient
information, charts and images, scheduling, billing,
insurance and more.
The best technology makes it possible to provide dental
care more effectively and efficiently with greater comfort
for patients and better outcomes. Done well, it all works
seamlessly. Our new division, Goetze Technology, is here
to help your office keep pace with technology changes in
the dental field. Our team guides your office in choosing
the most appropriate equipment and software solutions for
your office, along with providing outstanding service
and training.
“When you work as closely with dentists as we do, for as
long as we have, you’re tuned into the ways their practices
are changing and you can match that up with technological
advances to help them in their practice,” says Bryan Creason, technology manager for Goetze Dental. “We’re here
to help you put the right technology to work for the way
you practice.”
Take a closer look at the way technology can enhance your
practice and serve your patients.
Goetze Dental 800.692.0804 | www.goetzedental.com
1.800.328.2925 or visit www.xldent.com
279 North Medina Street • P.O. Box 1000 • Loretto, MN 55357-1000
Goetze Dental 2007
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something that might not have long-term viability. Today, I
can tell you confidently the time to implement technology
in your practice is now.
Dental technologies have passed from interesting concepts
to must-have devices and applications. Whether it is digital
or cone beam radiography, practice management software,
lasers, or any other high tech item, the current list of dental
technologies is definitely ready for prime time.
monitor and a second monitor is available for
the patient.
• Begin digital charting. Moving your charting from
paper to digital may seem a daunting task, but it’s easier
than you might think. The efficiency of digital charting
and treatment notes will save you hours
of time.
• Incorporate imaging. Using digital radiography and intraoral cameras allows the doctor to efficiently provide
and document treatment.
... a better informed public is seeking
predictable, high quality, high tech health care.
new technology
written by John Flucke, dds
We live in a digital world. It’s difficult to deny that the
continuing progress of information convergence is making our lives
easier and more efficient. Would any of us want to go back to a time
when we had to wait in line at the gas station counter or search for a
pay phone? The same is very true for the practice of dentistry.
Just a few years ago, people would frequently ask if I thought this
whole technology thing would really catch on. We dentists are a
conservative bunch. No one wanted to invest precious resources on
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Why is now a great time to move your practice into the
digital realm? At the ada Annual Session this past October,
u.s. Health and Human Services Secretary Michael O.
Leavitt spoke about the changes that need to be implemented to improve the u.s. health care system. Four of the
points he mentioned were:
• Electronic connectivity.
• Independent assessment of the care a patient receives
based on standards that medical specialists in the field
have established.
• Information on cost that is understandable and is
comparable.
• Competition.
The electronic connectivity Leavitt alluded to will require
a digital patient record complete with some form of digital
radiography. This will allow any dental office to send or
receive electronic records seamlessly. Putting the proper
infrastructure in place now means fewer struggles later.
If you are considering incorporating technology into your
practice, I make the following recommendations:
• Find a knowledgeable source for technology in your
practice. This should be as easy as calling your dental
supply vendor.
• Build the infrastructure. Use wired ethernet cabling
whenever possible.
• Start with the hardware. Put computers where you need
them, especially the operatories. If possible, use a dual
video system where the doctor and assistant have one
• At this point you can begin incorporating other items
such as lasers.
Technology has many benefits for the dental office. Even as
simple a change as computerized scheduling can provide
amazing benefits in staff efficiency and patient perceptions.
As you begin to embrace and expand your use of technology, you’ll begin to wonder how you managed to practice
without it.
So my best advice to you is to embrace the digital revolution … and do it now. Sit down with your sales representative and see how today’s state-of-the-art equipment and
software can make incredible changes in your practice and
your bottom line. The world is digital and a better informed
public is seeking predictable, high quality, high tech health
care. The question is no longer if technology is an option,
the question is when will you incorporate it.
The right plan begins with the end in mind. Set goals, get
help from experts and make the commitment. You’ll find
that the destination is well worth the journey.
Dr. John Flucke is a general dentist in private practice
in Lee’s Summit, Missouri. He has been involved with
computers, the Internet and computerized dentistry
for 13 years. He also blogs about technology and life at
blog.denticle.com.
Goetze Dental 2007
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How Cone
Beam Computerized
Tomography (cbct) works
demystifying
cone beam 3-D imaging
WRITTEN BY
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robert langlais, dds, ms
& marcel noujeim, dds, ms
These machines produce 3-d image data of the whole
volume in one scan. The rotation of the scanner may be
as little as 180 degrees; that is a half circle around the
patient’s head or varying degrees of rotation up to 360
degrees. Some machines perform a second rotation to create a larger volume by “stitching” two smaller volumes together. As the machine rotates, the radiation is pulsed and
each pulse results in image data. Usually more than one
pulse is generated for each angle of rotation. For example,
a machine with a rotation of 194 degrees may generate
300 images to complete the data set. Also, if the rotation
time is 17 seconds, the sum of the pulses may add up to
6 seconds of actual radiation exposure. The image data is
captured by a sensor and the manufacturer’s proprietary
software to study and analyze the scan. Usually this scan
data can also be converted to a dicom format so the scan
can be exported to a third-party software such as N-Liten®
or Simplant® to further display and manipulate the data.
features although some soft tissue details can be seen,
especially in air spaces such as the airway, nose
or sinuses2.
Scans in the dicom format are exported over the internet
to third parties for such services as Simplant conversions,
reports by oral and maxillofacial radiologists and the
construction of implant surgical guides and body parts by
various rapid prototyping or stereo lithography services.
The scans can also be put into viewer software and copied
There are two sensors used in cbvt. The first is an image
intensifier (i.i.) which was developed in Germany during
World War II. This sensor is subject to “distortion”
artifacts towards the periphery much like looking through
a “fish-eye lens” and “halation” artifact also seen as a dark
shadow at the periphery of the volume3. The i.i. sensor
Features in machine selection
Volume size
This is probably the first thing to look at. Volumes are
divided into three groups: large (17-20 × 20 cm), medium
(15 × 15 cm) and small (5-10 cm × 5-10 cm). In general,
smaller volumes offer sharper images than larger volumes,
especially if the larger volume is zoomed to obtain greater
detail of a limited area. Also, larger volumes may, in
general, involve more radiation; this varies however by
manufacturer. Additionally larger volumes require more
storage space. Some machines are capable of capturing
several volume sizes.
Sensor type
In general, small volumes offer sharper
images than larger volumes, especially
if the larger volume is zoomed ...
to a cd so other parties may view the images without the
need to purchase the viewer software such as E-Film®.
This usually includes a number of useful tools like making
1:1 measurements which are very accurate1. cbvt images
display excellent bone details and very poor soft tissue
may require service on a regular basis as it is prone to
correctable change over time with use. One manufacturer
(Morita) has discontinued the use of the i.i. sensor due to
these problems. Most cbvt machines are equipped with
the flat-panel silicon sensor. This device is not subject to
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size of 0.15 mm. Relatively speaking, small pixels are a
contributing factor to increased memory requirements for
viewing and storage and a slower processing time between
volume capture and the ability to view the images. Typical
processing times range from about two to five minutes.
Grey scale resolution
Cone beam vt produces digital images. When comparing
features, the “bit depth” will be touted as a prominent
characteristic to consider. Bit depth is often expressed
as 8-bit or 12-bit or even 16-bit. Current cone beam ct
machines are mostly 12-bit however several now offer
14-bit and at least one is 16-bit.
Machine configuration & footprint
Cone beam machines come in three configurations:
supine with an appearance much like medical ct, sitting
much like some pan and tomography machines and
standing resembling most current pan machines4.
Hybrid machines
significant degradation over time or to the abovementioned artifacts associated with the i.i. sensors. All
cbvt sensors are subject to the production of high density
“star spray or scatter” artifact and low density “beam hardening” artifact produced by metallic and some porcelain
materials including metallic or all-porcelain crowns and
implants with or without coatings.
These devices are capable of producing various modes of
digital images. Some cbvt machines are capable of generating a standard pan image or pan bitewing (not a 2-d
pan reconstruction) and/or a standard cephalometric view
(not a 2-d ceph. reconstruction). There does not appear to
be any loss of quality for the various standard image types
as a result of hybridization.
Pixel size
Computers, software keys, monitors,
server & HIPAA security
Regardless of sensor type selected, the smaller the pixel
size the better the image details (also referred as spatial
resolution). Pixel size varies from one machine to another
and often increases with volume size even in the same
machine. The range of small pixel sizes is from 0.07 - 0.19
A separate computer is usually needed and reserved
exclusively to capture the scans. In many instances the
manufacturer will insist on providing this computer to
ensure glitchless image capture. Several other computers
40 – 80 gb of hard drive space (for cases in use); and a
video card with at least 256 mb of integrated ram.
With the exception of viewer software, two types of keys
or “star spray” and appears as high density white lines
emanating from the source dense material. The other is
“beam hardening” artifact and is a low density black area
In both cases these artifacts
replace or wipe out the image of any
structures in the area.
are needed to open and use each copy of the software:
personal viewer keys and server keys. Most manufacturers will provide one or two personal keys and one
server key.
A monitor with excellent resolution must have a minimum of 1280 × 1024 and a dot pitch of 0.26 mm2 and a
brightness of 380 -420 cd/mm2 .
A server is needed for storage and retrieval of the 3-d
scans. Because most scans range from about 300 – 500
mb, ordinary computer hard drives will fill up rapidly.
Many servers are capable of adding additional hard drives
as needed. hipaa security is now an issue and required.
Limitations of CBVT
Firstly, all cbvt scans are subject to two types of artifact,
both of which are caused by dense materials such as
porcelain and metals5. The first is termed “star scatter”
paralleling one side or surface of a metallic object. In both
cases these artifacts replace or wipe out the image of any
structures in the area.
Reports by oral and
maxillofacial radiologists
Firstly, it is the responsibility of the doctor who is rendering the treatment to properly diagnose the case or make
the appropriate referral or consultations6. While most
dentists would agree with this, some believe that as far as
the radiographs go they are only responsible for recognizing problems relating to the teeth and surrounding bone.
This is not true. The responsibility is to detect any abnormality anywhere in the image such as lesion in the cranial
vault or base, the orbits, the cervical spine or any of the
paranasal sinuses in a pan or ceph. In the latest National
Council on Radiation Protection Report #145, orthodontists
are reminded they are responsible for recognizing any and
all disease visible on their ceph images.
Regardless of sensor type selected,
the smaller the pixel size the better
the image details will be ...
mm. Some machines offer several volume sizes with a
0.10 mm pixel size for the 5 cm × 5 cm volume and 0.30
mm pixels for the 15 cm × 15 cm volume size. Another
manufacturer offers a 15 cm × 15 cm volume with a pixel
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may be needed if the images are to be viewed at one or
more locations such as treatment planning and presenting
room, operatories or other office locations. These computers will require at minimum: dual processors; 2 gb of ram;
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Matching the Dentist’s
needs to CBVT Technology
Introduction
Because the technology is new and so revolutionary, many
practitioners are aware of cbvt and are fascinated by
the possibilities, but are uncertain about how to take full
advantage of the technology7. Certainly it is the mindset of
most dentists that they will own the radiology equipment
and others are aware that dental imaging labs exist and can
provide the services. Perhaps the best way to make a decision is for the practitioner to be well-informed. However,
while trying to become enlightened, doctors routinely
encounter a variety of dealer salespersons, manufacturer
representatives and colleagues where the potential for
undependable and sometimes conflicting recommendations are communicated - even though their suggestions
are made with the best of intentions. I believe the doctor’s
decision can be facilitated by first matching the dentist’s
imaging needs with a compatible cbvt machine and then
developing a business plan to make the adoption of the
technology work financially.
Choosing a small volume CBVT machine
The doctor’s needs may involve one or several of the
following examples: implant measurements & placement;
localization of impacted teeth such as third molars or
canines; endodontic applications such as finding the
cause of failure, extra roots or canals, root fractures or
exacting 1:1 measurements; periodontal applications
such as the visualization of bony defects or sub-gingival
calculus in three dimensions; volumetric calculations to
Choosing a hybrid CBVT machine
At the present time several cbvt machines are capable of
producing plain digital pan images and sometimes lateral
and ap cephs. The advantages of this combination are less
space needed and possibly lower cost than two separate
machines. Also, one brand of pan machine is upgradable
to cbvt (Planmeca Promax) and for those current owners
the cost of entry into cbvt may be among the lowest of all
possibilities. It also is possible to replace the current pan
machine with a hybrid pan-cbvt machine with advanced
functions, such as bite wing capability, perio mode,
subtraction and cephalometric functions all in the same
machine. Subtraction allows the practitioner to observe
and document subtle changes in teeth and bone over
time. Examples include tooth movement, sub gingival
calculus formation, continued periodontal bone loss,
regeneration of bone, osseous integration of bone grafts
and implants and the remineralization of enamel with
fluoride varnish procedures. The expanded use of the pan
machine for functions previously reserved for intraoral
radiography, as well as new previously unavailable technology such as subtraction, reduces the need for infection
control procedures and supplies associated with intraoral
imaging pans are faster and easier and often involve less
... several CBVT machines are capable of
producing plain digital pan images and
sometimes lateral and AP cephs.
determine the volume of bone grafting material needed
for a sinus floor lift to a specific height, or to fill all of the
bony defects of a planned periodontal surgical procedure;
space analysis for pediatric, implants and orthodontic
applications (tmj imaging is exquisite) or the creation of
3-d models of the teeth and jaws to replace study casts. All
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restorations and crowns and osseous integration of bone
around implanted metallic materials cannot be accurately
assessed due to cbvt beam hardening and spray artifacts.
cbvt renderings resembling plain images such as pans
and periapicals will contain the artifacts. Further, the
cbvt dose is higher than several plain intraorals or a pan.
However, a cbvt scan often is lower in dose than the 20
image full mouth survey. Plain intraoral, pan and cephalometric imaging is still needed. However, with the advent
of cbvt, the role of some plain imaging functions will be
obsolete due to the superiority of cbvt imaging for many
specific applications. There is no doubt cbvt is raising the
bar on the standard of care and can improve treatment
outcomes for many procedures.
of those examples represent applications that can be accomplished by a small-volume machine. This volume size
limits the viewed structures to those familiar to dentists,
involves less radiation to the patient, better image quality
than zoomed larger volumes, faster software reconstructions or renderings and less computer or server storage
space needs.
radiation dose. Such a pan machine can move from a
once-every-five-years use for an individual to everyday
usage for multiple patient needs. These expanded pan applications directly affect the business plan and contribute
significantly to offsetting the cost of the cbvt conversion.
references
Sakabe J., Kuroki Y., Fujimaki S., Nakajima I. and Honda K. Reproducibility
and accuracy of measuring unerupted teeth using limited cone beam X-ray ct.
Dentomaxillofacial Radiology (2007) 36, 2–6.
1
Holberg C., Steinhäuser S., Geis P. and Rudzki-Janson I. Cone-Beam
Computed Tomography in Orthodontics: Benefits and Limitations. J Orofac Orthop
2005; 66: 434–44.
2
Choosing a large volume cbvt machine
It is the belief of this author that the volume should be
kept as small as is feasible. However, there are those whose
needs will require a large volume machine. Some of these
include patients with facial trauma or developmental
abnormalities to be corrected by surgery and
or orthodontics.
Where & how to buy a cbvt machine
Cone beam machines are sold through dental supply companies and dealerships or directly from the manufacturer8.
For many doctors questions beyond the machine itself will
need to be answered such as reports, networking, computers, software, storage and software keys. The doctor should
be assured the seller has the entire technical backup team
to supply more than adequate support after the sale and
in-office training needs.
Parting Shots
Because of artifacts with current cbvt technology, a cbvt
machine other than a hybrid model as described above
cannot meet all of the imaging needs of most dental
practices. Caries under metallic and some porcelain
3
Katsumata A. et al. Image artifact in dental cone-beam ct. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2006; 101:652-7.
Danforth R. A. et al. 2003. 3-d Volume imaging for dentistry: a new dimension.
J. Calif Dent Assoc. 31: 817-823.
4
Katsumata, A. et al. Effects of image artifacts on gray-value density in limitedvolume cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2007 Apr 19 [Epub ahead of print].
5
Holmes S. M. iCAT Scanning in the Oral Surgery Office. omsnic Monitor,
February 2007 Vol 18 No 1.
6
7
Suomalainen A. K., Salo A., Robinson S. and Peltola J. S. The 3dx multiimage micro-CT device in clinical dental practice. Dentomaxillofacial Radiology
(2007) 36, 80–85 .
8
http://www.conebeam.com/?q=cbct-clinician/manufacturers.
This is an excerpt of the technical paper written by
Dr. Robert Langlais, dds, ms. To request a copy of the entire article, please contact Andrea Cross at Goetze Dental
at 816.413.1229 or via email at [email protected]
Dr. Langlais is a professor at the University of Texas
Health Science Center at San Antonio and directs the
graduate program in the specialty of Oral & Maxillofacial
Radiology. He has presented more than 400 courses and
lectures in his areas of expertise in countries encompassing all of the continents of the world, and has written 11
textbooks dealing with the subjects of dental radiology
and oral medicine.
Goetze Dental 2007
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of restorative dentistry for clinicians. The computer has
increased its influence in the dental field with digital
radiography and photography, and cad-cam restoration
fabrication. New techniques and philosophies also have
benefited our patients by providing alternatives to
aggressively prepared teeth and the use of aestheticcompromising metal.
The recontouring is useful during anterior aesthetic
reconstruction as well as a means to remove excess gingival tissue that compromises an ideal width to height ratio
of anterior teeth. Often, tissue recontouring combined
with teeth whitening can change an unattractive smile
into one that is dazzling.
One technology that has become increasingly utilized in
clinical dentistry is that of the laser. Initially introduced as
an alternative to the traditional halogen curing light, the
laser now has become the instrument of choice, in many
applications, for both periodontal and restorative
care. Although the laser offers many advantages over
other modalities of treatment, probably the greatest
impact it has made is the ability to be used for both hard
and soft tissue, often times without the need for anesthesia. The following are just a few examples of the many
applications of lasers in dentistry.
Whether it be a recommendation from an orthodontist
or for aesthetic concerns, the use of the laser is ideal for
both maxillary and lingual frenectomies. Since the laser
seals both nerve endings and capillaries, post-operative
discomfort and bleeding is almost non-existent, and the
need for post-operative suturing is eliminated as well.
Gingival recontouring
Since the mid-1990s, the application of the laser in
gingival recontouring has become the treatment of choice
for the aesthetic clinician as a means to optimize the smile
design process.
Prior to the use of the laser, tissue recontouring resulted
oftentimes in discomfort for the patient and lack of
predictability for the clinician. The use of the laser, more
Frenectomies
Periodontal treatment
The use of lasers in periodontal treatment has been well
documented over the past 10 years. When used in deep
periodontal pockets with associated bony defects, the
laser not only removes the diseased granulation tissue
and associated bacteria, it also promotes osseoclast and
osseoblast activity, resulting in bone regrowth.
Ovate pontics
The ovate pontic has become the choice of pontic design
for both aesthetic and cleansibility reasons. Success of the
ovate pontic is a result of developing an ideal site into the
gingival tissue.
Recent advancements in laser
technology have also allowed for their
use in hard tissue applications.
in dentistry
written by
David Hornbrook, dds
Dentistry has changed tremendously over the
past decade to the benefit of both the clinician
and the patient. New materials and technologies
have improved the efficiency and predictability
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specifically the Diode laser (Odyssey [Ivoclar], Continuum [HoyaConBio]) has provided a means to predictably reshape and recontour the gingival tissue to optimize
symmetry and maximize aesthetics.
The hemostatic nature of the laser eliminates the need
for retraction cord during restorative procedures and the
minimal zone of necrosis of the actual laser “cut” provides
a very stable final contour that will not change after the
definitive restoration is placed.
Since the ovate pontic actually replaces part of the natural
tooth root form, it is imperative to establish a recess
in the gingival tissue on the alveolar ridge to accept
the pontic form. Utilization of the laser, as opposed to
other methods such as electrosurgery or scapel surgery,
allows for immediate impression of the site for the definitive restoration.
Hard tissue applications
Recent advancements in laser technology also have
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allowed for its use in hard tissue applications. This is
especially true with the Erbium-yag laser (DElight
[HoyaConBio]). This includes enamel, dentin, caries and
osseous tissues. The Erbium also is excellent as a soft
tissue laser, performing procedures similar to that of the
Diode, but has expanded opportunities with the ability to
actually “cut” or remove hard tissue as well.
surgical methods, the healing time is usually 12 to 16
weeks to ensure osseous ands soft tissue stability.
With the Erbium laser, the gingival tissue is removed to
the desired level, regardless of the biological width. Using
a 400 μm tip with a setting specific to osseous tissue,
the laser is then placed parallel to the tooth surface and
With the Erbium laser, the gingival
tissue is removed to the desired level,
regardless of the biological width.
Although the laser has not replaced the high-speed handpiece in most tooth preparations, it certainly has become
a very useful modality to remove defective enamel and
dentin, especially in incipient lesions. Ideal applications of
lasers in restorative dentistry include class I, II, III, and
V preparations.
More often than not, these types of preparations can be
performed without the need for anesthesia, so the marketing benefits of laser dentistry has more than established
its value, especially in pedodontic- or adolescent-based
practices. Although not as fast as conventional handpieces, the elimination of the time needed for anesthesia
usually compensates for the lack of speed and often the
total time for preparation and restoration is shorter.
As far as osseous applications, the benefit of the Erbiumyag is the ability to recontour osseous tissue without the
discomfort and healing time commonly seen with traditional methods. In terms of aesthetic dentistry, the use
of the Erbium laser in crown lengthening in the anterior
has created an entirely new dimension in smile design.
With soft tissue-only removal, the extent of gingival tissue
removal is limited by biological width, which requires a
minimum of at least 2.5-3.0 mm between the free gingival
margin and the osseous crest.
placed under the tissue. The osseous tissue is then
recontoured to the ideal level to establish a healthy
biological width.
Although long-term clinical studies are certainly indicated, anecdotal and short-term clinical experience indicates
the osseous levels remain at the newly contoured level,
and many clinicians actually take definitive impressions
for restorative at the time of osseous recontouring.
As technology advances into dentistry, whether it is
laser or another exciting venue, the options available to
clinicians will continue to increase. Although the use of
lasers in dentistry is relatively new, the future looks very
bright. Admittedly, more long-term clinical and scientific
research needs to be done to validate anecdotal clinical
experience and claims, but preliminary use and experience appears very positive. As with all new technologies
and philosophies, proper case selection and understanding of the contraindications and limitations is mandatory
for predictable success.
Dr. Hornbrook, dds is an icon of the new generation of
aesthetic dentistry and has been voted by his peers as one
of the top three lecturing dentists in the nation. A gradu-
If the requirement to optimize aesthetics violates this
measurement, the only option is to remove osseous tissue
to establish a healthy biological width. With traditional
ate of the ucla School of Dentistry, he has pioneered the
concept of dental excellence through hands-on courses
using all the latest technologies, including lasers.
Goetze Dental 800.692.0804 | www.goetzedental.com
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Goetze Advantage
PROGENY DENTAL
Preva DC
Intraoral x-ray
A powerful feature combination
for your digital office
| 0.4mm focal spot for detailed, crisp images
| Adjustable techniques for optimized images:
kV—60, 65 or 70
mA—4, 5, 6 or 7
Time—10ms to 2 seconds
| Unique sensor selection feature
| Unique LED display with bright, easy-to-see text
| 30 pre-programmed anatomical settings speed workflow
| High performance digital compatibility, plus high speed and standard films
| 56" 66", 76" arm lengths
| Mobile model also available
More Than Imaging.
Excellence.
Who says you can’t have it all?
ANOTHER BRIGHT IDEA FROM DEMETRON
Midmark Operatories reflect you and the care you provide, offering
the most in innovative design, clinician access and patient comfort.
• Light weight and ergonomic. Multiple holding options. Reduces hand and arm stress.
Midmark offers a full line of dental products including reliable
instrument delivery units, chairs, lighting, seating, casework, sterilizers,
vacuum pumps, air compressors and nitrous oxide delivery systems
to complete the ideal dental practice.
• Periodic Level Shifting (PLS). Shifts output from
1,100 to 1,300 mW/cm2 for a true 5-second
cure (A3.5 and lighter). No excess heat.
• Interchangeable lithium-ion batter y. Longer in-use battery life.
500 5-second cures with a fully charged battery.
Now, you can have it all…from a trusted company who recently
celebrated its 90th year.
For
Dental at
800.692.0804.
Formore
moreinformation,
information,contact
contactGoetze
your Goetze
Dental
Representative,
call 1-800-MIDMARK or visit midmark.com.
Order Information
©2007 Kerr Corporation
910770
*Pending 510k Clearance. This product will be offered
for sale after Kerr receives FDA market clearance.
Demi LED Curing Light System (120 V)
Complete with Handpiece, 8 mm Turbo Light Guide, Battery Pack,
Battery Charger, Power Supply, and Protective Light Shield
Your Practice is Our Inspiration™ • KerrDental.com
• 800.KERR.123
Goetze Dental
Midmark Corporation 60 Vista Drive, P.O. Box 286 Versailles, OH 45380-0286 1-800-MIDMARK Fax: 1-877-725-6495 midmark.com
Goetze Dental 2007
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purchases are acquired in the last three months of your tax year
(Mid-Quarter Convention). This hazard can potentially reduce
your first year depreciation to 1⁄8 of a year’s depreciation.
Tax Tip Health care providers can use Class Life 57 pursuant to
Rev Proc 87-56 to allow five-year depreciation period for furniture
and equipment. The normal depreciation period is seven years.
Super Tax Tip The all-important exception to the general
depreciation rule is that you can elect to treat a certain amount
of equipment purchased and placed in service as though it was
supplies and get an immediate expense deduction in the year you
purchase. Your tax advisor has likely referred to this as the Section
179 deduction. The allowable limit for 2007 is $112,000 and current
tax law calls for the allowable limit to fall back to $25,000 in 2010.
Time your purchases to take advantage of this election.
Tax Trap If you personally buy the equipment and lease it to your
pc (professional corporation), you are not in a trade or business, so
you can not take the first-year deduction.
Tax Tip If you purchase seven-year and five-year items in the same
year, elect to expense the seven-year items first, since that reduces
the longer depreciation items.
The best time to purchase and whether to buy hinges on a
very simple principle: buy when the investment will
produce enough new revenue to be necessary.
Treat the purchase as an investment. Expect to create new
revenues and justify the purchase through proper planning
and analysis. Remember to consider all the benefits and
consequences that taxes play in your purchase.
Maximize depreciation and
first-year deductions
When you purchase major items, such as equipment, for
a trade or business and place them in service, you are
required to depreciate the cost over a life specified by the
Internal Revenue Service (irs). This is typically seven years
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Goetze Advantage
for traditional equipment and furniture and five years for
computers and some electronic devices.
Tax Trap The irs considers depreciable equipment to
be anything with a life expectancy over one year.
However, some people consider items amounting to a
few hundred dollars as dental supplies. Be aware that is
technically incorrect.
Potential Tax Trap Be aware of the deprecation
exception when more than 40 percent of your asset
section 179
work for you
Make note of these important aspects
and requirements for Section 179:
• An election must be made in the first year the
equipment is purchased and placed in service
– it is not automatic. You can make the election
only during the year in which the equipment is
purchased and placed in service.
• The election is allowed only for items used in a
“trade or business.” Rental real estate activities
generally don’t qualify.
• Section 179 deduction is only fully allowed
($112,000 for 2007) if your equipment purchases
for the year are less than $450,000.
• The Section 179 limit applies to your entire tax
return not just each business. Accordingly, you
and your spouse may have separate businesses,
Tax Tip Understand the difference between an operating lease
but you are limited to a total $112,000 deduction
and a capital lease if/when it is suggested that you use a lease to
finance the equipment. Reading the lease document is important
and necessary.
between the two of you. Similar problems arise
Building cost segregation
written by keith e. heil, cpa/pfs
making
Are you considering building an office? Consider the value of
having a study performed to segregate the costs of the building
or build-out into elements of the building that may be separately
depreciated using shorter depreciation lives.
if you are a member of several S corporations or
partnerships which pass through your share of
the deduction.
• You can specify which items are to be expensed.
Consider the benefit of electing longer-life items
first or assets acquired in the last three months
of the year.
• Don’t view Section 179 as a must. There are
cases where the election is not beneficial and the
Tax Trap If you are considering a building and performing a
deduction is wasted because very little income
cost segregation study, be mindful that amounts segregated into
personal property count towards the Section 179 bucket and,
depending on placed-in-service date, could cause Mid Quarter
Convention to apply – plan accordingly.
was produced in an early year of practice or you
Tax Tip Generally, the tax savings benefit for performing a study
can be as much as 10 percent or more of the cost of the building
(land excluded).
If you are considering equipment purchases, a new office, or
leasing, meet with your accountant or tax advisor. Many of the
tax traps identified can be eliminated with good planning, which
includes starting early.
happen to be in a low tax bracket.
• Leasing equipment does not qualify. You must
purchase the equipment.
• Generally, you cannot use Section 179 to create a
business loss.
Keith E. Heil has more than 15 years experience as a financial advisor. He currently is with
Cornerstone cpa Group, pa.
Goetze Dental 2007
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&
Arias
archaeology
If you can’t find Gregory Oehmen, dds, in his suburban St. Louis
office, chances are you’ll find him walking the plowed fields and
river bottomlands of the area looking for ancient artifacts.
His interest in this millenniums-old culture and its subtle
presence around the hustle of St. Louis runs deep, and he’s
ready to share what he’s learned from years of walking the
fields, bluffs and rivers’ edge.
You might also find him on his bike. He logged 1,800 miles
last summer and plans to do the ms150 in Columbia, Missouri, in September.
Think you’ve pegged Dr. Oehmen? Think again.
“It’s pretty cool to hold a stone tool in your hand that
hasn’t been touched by another human for thousands of
years,” he says.
What triggered his interest? “Years ago I was camping
with my kids and found an arrowhead,” he says. And
that was that.
If you can’t find Dr. Oehmen finding tools, knives and
dart points from another civilization, check the streams of
Wyoming and Montana. He could be fly fishing — unless
“This surprises people: I’m an opera fan,” he offers. His
favorites: Puccini’s La Boheme and anything by Mozart,
but especially Don Giovanni. “Then there is a contemporary one, Nixon in China — it was wonderful opera.”
Archaeology, fly fishing and opera? “I have been a fan
of classical music since I was a kid. I discovered a box of
45s — my sister’s, I think. It was six or eight records with
Carmen.” Does the good doctor sing or have other musical
talents? “I took piano and failed miserably. I didn’t have
“It’s pretty cool to hold a stone tool in
your hand that hasn’t been touched by
another human for thousands of years.”
it’s winter, when he’ll be tying flies at home. He also makes
his own rods. “It’s not that hard,” he says. Come fall he’ll be
duck hunting and in spring it’s wild turkeys.
By now you’re getting a picture of Gregory Oehmen. Like
most dentists, he is good with his hands. He’s currently
remodeling the master bath in the home he shares with his
wife of 40 years, Judy. He and Judy raised three kids, two
sons and a daughter; no dentists.
the discipline.” And no, he can’t carry a tune. “I even hum
badly,” he muses.
He sounds humble and wonders how an ordinary guy like
himself wound up leading an amazing, wonderful life. His
relationships with patients are steady and strong. “They’ve
become my friends and I enjoy going to work. I am
grateful for what life has done for me.”
Goetze Dental 2007
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Why is Forest Dental Goetze’s fastest
growing equipment manufacturer?
GET A $
Dentists have discovered that the savings they
realize from Forest's Affordable Excellence
expands their purchasing power for high-tech
equipment such as digital x-rays, cameras and
computer systems:
150 REBATE!
High frequency range for superior
safety and efficiency.
simply smart business.
Whether you choose the traditional shade of
white, or one of our 13 designer friendly paint
colors, no manufacturer offers more equipment
options than Forest. If our equipment does not
meet your requirements, we can custom fabricate
to meet your specific needs. Send us your intraoral camera, electric hp system and the like, and
we will guarantee its installation at our factory.
Ideal for both digital and film systems.
Kodak 2100
Intraoral X-Ray System
forest
AFFORDABLE E XCELLENCE
Kodak 2200
Purchase a Kodak 2100 intraoral x-ray
system or Kodak 2200 intraoral x-ray
system from July 1 – September 30,
2007 and receive $150 rebate – visit:
www.kodak.com/dental/specialoffers
for full details and a submission form.
Intraoral X-Ray System
To place an order or for more information
call 800-692-0804
www.forestmed.com
LEADER
PACK
OF THE
At Brewer Design, finding the proper fit
matters most. Our chairs are designed using
clinical ergonomic standards developed and
Goetze Dental 800.692.0804 | www.goetzedental.com
CELEBRATING
60 YEARS OF
ADVANCING
ERGONOMIC
SEATING BY:
researched to assure the proper size and fit to match you.
• Increasing
productivity
Put your trust in the leader.
Contact your local
dealer for more
• Relieving back
and neck pain
• Preventing
musculoskeletal
disorders
• Improving overall
seating comfort
information on our
extensive ergonomic
EG-9000
Series
seating line.
EGF-9100
Series
EG-9200
Series
The Midmark M11 offers the largest capacity of any standard tabletop
sterilizer on the market, with an 11" x 18" chamber. More capacity allows
you to process more instruments with less sterilizer loading and unloading.
With a patented automatic-opening door, the Midmark M11 sterilizer is
the most efficient when it comes to properly sterilizing and drying your
instruments. Simply load it, set it and forget it!
The Midmark M11’s Steam-Flush Pressure-Pulse Air Removal System
is so effective that it can pass the air removal tests required on more
complex vacuum steam sterilizer systems, thus ensuring good steam
penetration for complete sterilization while increasing the sterilizer’s
reliability.
Make the industry-leading sterilizer your choice for sterilization and have
peace of mind.
For more information, please contact your Goetze Dental
Representative, call 1-800-MIDMARK or visit midmark.com.
Midmark Corporation 60 Vista Drive, P.O. Box 286 Versailles, OH 45380-0286
1-800-MIDMARK Fax: 1-877-725-6495 midmark.com
46
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Goetze Advantage
Goetze Dental 2007
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47
P O W E R F U L
Experience the Power of Evolution.
Introducing the NEW Power Series from Midmark.
The high performance you need. The name you
can trust.
For more
more information,
contact
your
friendly
Goetze
For
information,
contact
Goetze
Dental
Dental
Representative, call 1-800-MIDMARK
at
800.692.0804.
or visit midmark.com.
Porter’s breakthrough MXR-D Flowmeter.
Instantaneous flow of gases, combined with the
convenience of digital readouts.
Nitrous has never been easier to administer.
Put this new cabinet-mounted flowmeter on the
menu to nourish your nitrous practice.
Midmark Corporation 60 Vista Drive, P.O. Box 286 Versailles, OH 45380-0286
1-800-MIDMARK Fax: 1-877-725-6495 midmark.com
www.porterinstrument.com
Quality you can afford...
Technology you can depend on
ERGONOMIC
TECHNOLOGY
ORGANIZED
Improving the ergonomic
principles of the entire
dental team and facilitate
access to the oral cavity.
Integrating technology in
a manner that enhances
patient care without compromise.
Designing clean, organized work environments
that foster efficiency and
healthy procedures.
VALUE
FLEXIBILITY
RELIABILITY
Delivering durability,
function and superior
materials for a fair price.
Offering the widest range
of products and options
to provide custom solutions.
Supporting the dental industry for over 30 years
with a superior group of
field representatives and
full-service dealers.
www.royaldentalgroup.com
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www.goetzedental.com