One Easy Method That Will Increase Restoration Accuracy by Customizing An Articulator to the Actual Angle of the Eminence

When we rely too heavily on ‘assumptions’ to determine the angle of the eminence during a restoration, we risk creating a faulty end result for a significant amount of patients.

About 80-85% of patients will not present an issue. You can set the angle of the condylar path on the articulator, basing your efforts on a design assumption that most patients have an eminence with a steeper angle. The lab creates posterior disclusion on the articulator and there is equal or greater disclusion.

Problems arise when you end up with a patient who falls into one of two eminence categories.

Two Types of Patients Who Need Customization to the Angle of the Eminence

For 15-20% of the patients you treat, customization is necessary. These patients often fall into two categories:

1. Eminence is flatter than the assumption.

The restorations did not touch on the articulator, yet you’ll have to remove posterior differences chairside in these patients.

1. Eminence is steeper than the assumption.

These patients tend to experience less chewing efficiency. They complain that bits of snack food pack onto their restorations. This packing occurs on the occlusal table.

In both cases, a solution is needed. Creating posterior excursive disclusion or interferences relies on how well the angle of the eminence works with the angle of the anterior guidance. To achieve great results for patients outside the norm, there are two options.

How a Photograph Can Enable Restoration Customization

Accuracy is the ultimate goal for final restorations. Many dentists who find themselves dealing with a patient in the less common eminence percentile decide to take a protrusive bite record. My advice is to choose an alternative option that requires less effort.

The easier way also uses a semi-adjustable articulator. You still customize the articulator to match the patient’s actual angle of eminence. But instead of the protrusive bite record, send the lab an end-to-end retracted photograph.

For this image:

• The incisors should rest on the incisal edges.
• The second molars should be visible and in focus.

The lab can use this image to create posterior disclusion. They simply dial the condylar setting to match the photograph and use a sharpie to record it on the model.

What method do you prefer for customizing the articulator? We’d love to hear from you in the comments!

One pattern I’ve noticed lately in calls with my clients is that many dentists and their teams are frustrated about training new hires. Adding a unique personality to an already cohesive group can seem like mixing oil and water at first. When a new team member is brought into your dental practice, there needs to a consistent plan in place to avoid or manage problems as they arise.

 Starting the Conversation on Training New Hires

The frustration I’ve come across is consistently based on new hires not catching on, not doing things the ‘right way,’ and not doing things as fast as dentists would like. The seasoned team members are irritated and everyone is annoyed by the amount of work it takes to train.

One of the conversations I have with my doctors is about understanding the difference between exposing a new team member to a task or philosophy and having them actually learn it in the way they are most suited to. I ask:

1. At what point would you say they’ve started to have a certain level of competency where they can do the task?
2. At what point would you say this team member has mastered what it is you want them to do?

The hope is that you bring a team member on board, they watch what’s going on, you show them a few times, and they will automatically and miraculously have a high level of mastery. But this is not the case for most people.

Pay Attention to Individual Learning Styles

There are many different learning styles that can affect how a person takes in and processes information. Some people want to read about it, some need to watch it five times, and others have more hesitation about how fast they get it.

Acknowledging different learning styles is a huge component to successful individualized training. You have to understand how different people will become effective and learn what you want them to.

3 Steps of Dental Practice New Hiring Training

I like to look at the training process as a continuum:

1. What was the first exposure and have they been exposed to how you actually want to have the task done?
2. What will it take for them to have a measurable level of competency? Is there a training checklist in place? Who is responsible for helping this team member learn?
3. What would it look like if and when they ever attain a level of mastery to the point where they could be responsible for teaching another person?

Bonus Tip: Most people really struggle with only oral types of instruction. Having things in writing and experiential learning are both helpful.

Most importantly, it’s crucial to enact the basic training continuum: exposure, competency, and mastery.

You have to have an actionable plan and you need to know who is accountable for it. If you’ve been unsuccessfully training a new team member, this process has a high level of predictable success, assuming you’ve hired well to start with.

What tasks do you find new hires struggle with the most in your dental practice? We’d love to hear from you in the comments!

(Link to Getting Team embers to ‘Pull On the Rope’ Part 1)

Questions That Will Improve Team Engagement

Employees in a dental practice need to feel valued on multiple levels to do their best work.

In Part 1 of this series, I discussed the importance of team engagement and how it affects a business’ success. Below, I dive into the fundamental needs that can change your team’s satisfaction with their day-to-day employment.

Understanding the 4 Team Needs That Will Change Your Practice

Wagner and Harter’s 12 elements from “12: The Elements of Great Managing” are divided into four categories based on the concept of a triangle and Maslow’s Hierarchy of needs. The first two have to do with basic needs, the next four with individual. If those are met, the next four have to do with teamwork and the final elements are related to growth.

Basic Needs

Example: The first element that must have ‘yes’ as an answer is, ‘I know what is expected of me at work.’

This is the most important category. When people know what’s expected of them, their basic needs are met and it’s easier to move on to their individual needs.

Individual Needs

Example: Element four is, ‘In the last 7 days, I have received praise for doing good work.’

This is about recognition for team members that do good work. You must make sure they’re in an environment where that type of response is supported.

Teamwork Needs

The next need is teamwork. I find it interesting that Gallup asks about best friends. Certainly something I see with my own team is that when team members are actively engaged in relationships with each other, they come to work engaged because of those friendships. They don’t call in sick because they want to spend time with their friends at work.

Another example: Element seven is, ‘At work, my opinion seems to count.’

I’m a fantastic micromanager and I always think I have the best ideas. The more I’ve given up on that, the more I’ve noticed my team members are happier with what they’re doing.

Growth Needs

And lastly, growth.

Example: The final element is, ‘In the last year, I have had opportunities to learn and grow.’

Employees need to feel challenged in their tasks, not bored or stuck in stasis.

My encouragement is to look through the Gallup Q12 Index questions and consider whether you have had similar conversations with your team members individually. Ultimately, if your team members can respond affirmatively to these questions in your practice, then I’m sure you will discover that they are ‘pulling on the rope.’

How do you help your employees have a more fulfilling work experience? Please leave your thoughts in the comments!

3 Types of Team Members Who Make or Break Success

Keeping team members engaged throughout the year is a struggle if you don’t have a communication-based framework in place.

During a recent course I received many questions about how I get my team members engaged. This left me reflecting on lessons I’ve learned over the years from research by the Gallup organization.

Read on to learn what causes disengagement and how you can avoid the downfalls of a disgruntled team in your practice.

The 3 Types of Team Members

In the book, “12: The Elements of Great Managing,” Rodd Wagner and James K. Harter use research from Gallup to describe the three types of team members that exist in corporate America. I believe these types are applicable to dentistry as well:

1. Engaged: They have the magical ingredient of passion.
2. Not Engaged: Pretty much checked out. They put in time but there’s no energy in their work.
3. Actively Disengaged: They’re not only unhappy, they actually undermine what engaged team members try to accomplish.

How Engagement Determines Business Success

What the authors found is that the ratio of engaged to actively disengaged employees is quite different in highly productive corporations versus average corporate America.

Engaged team members in average corporate America were 30% versus 63% in highly productive organizations. Similarly, not engaged was 29% in the highly productive versus 50% in the average. Most shockingly, the actively disengaged employees were more than twice as high in the average corporate office: 8% versus 20%.

This had me thinking of the analogy of a 10 person bicycle. Three people are pedaling really hard at the front. Five people have their hands on the handlebars but their feet are up in the air and they’re not pedaling. Then there are two people way in the back who are actively holding onto the break. This either means a stalling ride or one that could be much faster if everyone were like the first three.

The 12 questions in the book and their corresponding need categories are useful for sussing out what matters most to promote engagement. They show us what can we do about low morale in our dental offices.

Look for Part 2 of this blog series next week where I’ll outline the four team needs that will change your practice.

What do you do when you notice team members are disengaged? Comment below with your thoughts!

(Link to Getting Team Members to ‘Pull On the Rope’ Part 2)

The life of women who are intent on their careers is often fraught with the struggle to be everything to everyone. Many women wish there was one ‘secret’ that could make the sacrifices and dedication easier, but in truth there are many. The best way to discover them is to rely on the advice and past experience of other strong women in dentistry or similarly taxing careers. You have to be comfortable standing on the shoulders of giants.

My preparations for the ‘Making It All Work’ women’s retreat at the Pankey Institute have gotten me thinking about many of the challenges facing women in professional settings. Dr. Lee Ann Brady, our insightful retreat facilitator, posed the question, “What would you do if you had two days to focus on yourself?”

This got me thinking about one of the keys to my success and how I achieve a work-life balance.

How Cultivating Leadership Can Create Work-Life Balance

One of my secrets to success is leadership. I am able to leave the Institute while we have a class going on because I’m confident in the resiliency of my team’s intentions. I know that even though I’m not there, our team culture ensures the same dedication to providing an excellent experience that I would enact if I were there.

Leadership is the core of what helps me be successful and develop a work-life balance. It’s one of the primary topics that we ponder in the women’s retreat, as well as financial freedom and ownership. If you’re searching for career secrets, the path to balance definitely starts with leadership. I shared my experiences and tips at the course. It’s a weekend dedicated to us – women who are passionate about their careers.

What secrets of achieving a work-life balance keep you stable and energized? We’d love to hear your perspective in the comments!

More than anything, Pankey is a family that grows every year to include a wide variety of dentists practicing across the world.

One thing we all have in common are many of the thoughts that ran through our head during our first Pankey course. These range from the personally insightful to the downright hilarious.

5 Thoughts Dentists Have During Pankey Essentials 1 

1. “I wish I lived on a beach island.”

As you leave Miami to cross the Rickenbacker Causeway and enter Key Biscayne, you begin to realize why Pankey is where it is. Mangroves line the sparkling blue coast and you pass a long strip of sunshine-soaked public beaches. Lush greenery rises up on both sides of the road. Soon you’re arriving at the literal paradise of a tiny island dotted with luxury resorts, mansions, and amazing Cuban food. Speaking of Cuba…

2. “I probably shouldn’t have had that third Cuban coffee this morning.”

You may have been warned about the super-strength effects of a Café Cubano, but the cups were just so small and unassuming (and let’s admit it, delicious) that you downed two to three in quick succession. Not long after, you got a jolt of razor sharp caffeine. Baptism by fire, as they say. You show up to the Essentials 1 (link) course introductions and realize you’re nodding like a maniac to everything the instructors say. Don’t worry, they love the enthusiasm.

3. “I didn’t expect to meet my best friend in dentistry.”

You’re getting to know people who aspire to practice dentistry the same way you do. It’s eye-opening to discover you aren’t alone in wanting to sharpen your skills and create a professional lifestyle that leaves you passionate rather than exhausted. You’re already forming lifelong relationships with dentists who will become genuine friends as you walk similar paths toward career fulfillment.

4. “I have a lot to learn.”

Dentists who sign up for E1 are usually hungry for growth in their professional lives. You take the CE because you want to learn about occlusion and how you can do higher-end restorative dentistry. As the lessons build, your desire to practice the way you’re being taught multiplies, but you also realize it will be a long path of dedication. You didn’t expect to learn how you could design dentistry so that you could truly love it. Pankey CE changes your perception of the care you can offer and feeds the flames for further learning.

5. “I’ve finally found my home in dental CE.”

No matter how long you’ve been in dentistry (or even right at the beginning), there comes a point where you wonder, ‘Is this as good as it gets?’ After coming to Pankey and being immersed in the inspiring philosophy, you find that the answer is, ‘No, it can always get better.’ You’ve become part of a community that yearns for more satisfaction in their careers. You’ve finally found your dental home.

What revelations did you have during your first Pankey course? It would be awesome to hear from you in the comments!

Why You Should Determine Value Before Chroma and Hue When Matching Shades for Composites

The true artistry of the dental profession tends to show itself in many of the more challenging requirements of cosmetic dentistry. One of these areas where we can express our esthetic skills is in shade matching for composites. The struggle arises in understanding the various properties of natural-looking teeth and determining what visual aspects to match first.

 Composites 101: Defining ‘Shades’ and Their Components

Before you can begin to choose which aspects of a natural ‘shade’ to preference, it’s integral to delve into the nature of these complex components.

Reflectiveness and translucence combined determine the appearance of a tooth. Reflective properties are especially important for shade matching because this is the true definition of ‘value.’ Value tends to be defined as the coloring on a range of white to grey, but it’s actually a measure of tooth reflectiveness.

Other esthetic qualities of dentin and enamel include ‘chroma’ and ‘hue.’ A classic numeric scale of 1 (lowest) to 4 (highest) is used to judge chroma, which simply refers to the intensity of a color. Hue, on the other hand, is generally deconstructed into the letters A, B, C, and D. These indicate the names of color.

‘Shade’ is simply the end result when all three parameters of value, intensity, and hue are viewed together. The key lesson here is that these parameters must be matched separately. To achieve the best case outcome, you must rank them according to importance.

Should You Shade Match for Value, Chroma, or Hue First?

This is where things get tricky and we start to juggle multiple considerations at once.

Layering is paramount because dentin shades and light properties differ in composites versus real dentin. This is also true for enamel shades. Added to these differences is the fact that dentin and enamel do not have the same amounts of reflectiveness and translucence. Basically, you have dentin and enamel discrepancies between composites and real teeth in addition to the discrepancies that exist between dentin and enamel.

Precision will impact the final appearance of the tooth, so it’s important that you layer composites to get around these discrepancies. The composite materials selected should match for value before chroma and chroma before hue. Because final value is a blend of the individual values of every composite layer, you must consider that each layer is not going to be representative of your intended value. They build on one another to create life-like reflectiveness and translucency.

A Method You Can Use for Determining Value in Composites

My favorite method for constructing an esthetically superior value is to start the appointment with layering. I plan what composite shades I want to combine ahead of time and work efficiently so that inevitable teeth dehydration doesn’t affect my results.

I layer the materials on the labial of the adjacent tooth in their final thicknesses and photograph the outcome. This allows me to see if my chosen combinations match my esthetic goals and troubleshoot if the composite doesn’t disappear against the tooth. When I’m not happy with the look, I easily pop the composite off the tooth and re-do the process. I only begin to contemplate chroma and hue once I’ve matched the value.

How do you troubleshoot shade matching issues in your esthetic cases? We’d love to hear your perspective in the comments!