The end of 2017 is wrapping up a solid year of incredible dental blogs from our talented Pankey contributors. Our posts featured everything from techniques for occlusion and orthodontics to practice management and leadership.

There are tons of useful tips and plenty of information for dentists at every stage of their career on the Pankey Gram. Here, we’re compiling five pieces of sound advice from blogs in 2017 that are sure to get you excited for another year of practicing dentistry your way.

As Pankey dentists, we continue to strive for greater learning and growth in our professional and personal lives. Revitalize your hunger for education with these thought-provoking tips:

5 Clinical Tips From 2017 Pankey Blogs

1. Consider physiologic changes that occur over a lifetime when planning restorative dentistry.

In his blog on ‘Adult Growth of the Dental Arch,’ Dr. Roger Solow explored the slow craniofacial growth that can affect dentistry throughout a patient’s life.

2. Set splint therapy fees in such a way that you can actually make money off them.

In his blog, ‘How to Set Splint Therapy Fees,’ Dr. James Otten described how to individualize splint therapy fees and more accurately estimate therapeutic time.

3. Think like an orthodontist when advising patients on post-ortho care.

In her blog, ‘How Long Should Patients Wear Their Retainers Post-Ortho?’, Dr. Lee Ann Brady laid out important considerations for dealing with questions about retainers.

4. Recognize when patients are in denial and practice empathy toward them.

In her blog on communication, ‘From Denial to Acceptance and Action,’ Mary Osborne RDH enlightened with a description of patient denial in dentistry.

5. Improve you protocol for restorations by adding another dental assistant.

In his blog, ‘6-Handed Bonding,’ Dr. Mike Crete made his case for why an extra dental assistant can benefit dentists dealing with adhesive dentistry and tricky restorations.

And there you have it folks. Best wishes for 2018! 

Customer equity in the dental practice is the retention of existing patients and attraction of new ones. This ensures patients can have more of the dentistry they don’t realize they need. So how do you find and retain new patients?

Asking for New Patient Referrals

New patients come from a combination of invitations, referrals, and marketing. You can have much more control over internal marketing than external. This is the environment you create in your practice that incites patients to refer you to their personal networks.

You must create a safe, non-judgmental system for asking for referrals and having those important conversations in your practice. Most importantly, you must choose the right patients to ask, because some will be too difficult or unreceptive to the question. Some may also be patients that you don’t want extensive relationships with. In that case, you may thank them for offering, but make it clear you aren’t looking for new patients with a soft statement.

Asking for new patient referrals is made easy by the fact that you usually know immediately which patients will be receptive. These are the model patients who pay bills in a timely fashion, care about your suggestions, and are just generally amazing for whatever reason.

Identify potential patient ‘marketers’ in your morning huddle on a regular basis. Then pose the question to these patients in a casual, non-aggressive manner. You can be joking, vulnerable, honest, reserved … whatever tone you think will work best with that particular patient. The request should flatter them or feel good to them.

This is how you create and seize opportunities. It can also occur naturally if they compliment you, but there is no shame in being upfront about asking for referrals.

How do you handle patient referrals in your dental practice? Leave your thoughts in the comments! 

White and brown spot lesions on the anterior teeth can be very distressing for the patient and a frustration for clinicians. Normally, they are decalcification or deposits on the teeth from fluoride or other minerals.

They do not require restoration. We are hesitant to do this and sacrifice good tooth structure, but esthetically they can really bother patients. They reduce a patient’s confidence in their smile. Recently, I have found a solution to this clinical situation that meets both the patient’s esthetic demands and my desire to be conservative.

Reversing Lesion Color on Anterior Teeth

Icon, from DMG America, is a translucent resin infiltrate that reverses the color of the lesion. It brings the tooth back to its natural color, requires no tooth preparation, and protects the tooth from further decalcification or progression into a carious lesion.

After we isolate with a rubber dam, the tooth is etched with a special etchant included in the kit. The protocol requires a longer etching time then we are accustomed to with other procedures.

After each etching procedure, we rinse and dry the tooth. Then we apply a special drying agent that allows us to evaluate the final result prior to proceeding with the resin.

If the tooth color has not yet been optimized, the etchant is applied again. This can be repeated up to five times. Once we have completed the etching process and confirmed the result with the drying agent, the resin is applied and then cured.

The entire procedure is done without any anesthesia and is very comfortable for the patient. Icon can be used on the facial and also on interproximal areas.

The resin is not visible on an x-ray, so the kit comes with a card to give the patient. This is so that if they see another dental office in the future, they are aware that the interproximal areas will still appear decalcified on an x-ray but have been fully infiltrated with resin.

I really enjoy offering this incredible, conservative esthetic service to my patients.

Dr. MacDonald continues Know Your Patient

What is always attractive to quality individuals is the same thing that is attractive to quality patients and the rest of the people in your life. Building strong relationships with your team will have a direct influence on developing good relationships with patients, but first you have to demonstrate attractive leadership qualities.

Delivering Relationship-Based Leadership

To me, the following statements are a safe place to start for attracting and sustaining talented team members:

1. You, the leader, believe they are important and their role is important and valuable to you.
2. You view each person as unique, valuable, and worthy of your respect.
3. They perceive the opportunity for growth and development (both skills and income).
4. They are given the authority to make decisions and have responsibility for their part of the practice.
5. They are on a team that can count on one another because they trust each other.

There are many more important aspects, but you get the idea. Your team is an extension of you. A caring high trust relationship between the dentist and their team that is observed and experienced by the patient will help the patient build trust with both. In fact, it is probably the key to the patient trusting you.

Belief & Trust

When we refer a patient to one of the specialists or technicians on our interdisciplinary team, it is made with confidence and conviction. That is possible because we know the doctor or technician and their team very well. We believe in their clinical skills, their integrity, and how they manage our patients.

This is the result of intentionally selecting each specialist and developing a relationship with them and their team. In that process, we have developed a protocol that outlines what we can expect from one another and what each of us is responsible for. We spend time together individually and as teams. They know how much we respect and value what they do. They express the same in return.

Knowing your patient is a model for the nature of your work and how to approach all of the key relationships in living out your WHY. Practicing this way makes dentistry much more rewarding and enjoyable. Enjoying all of the people in my practice world is what I want and how I want to experience my career. Thank you Dr. Pankey and all who have brought this to life for me and for many!

Knowing your patient beyond their surface structure is essential. It is a process of discovery that is fueled by curiosity. In my view, the critical elements include:

1. Building trust
2. Understanding the value and uniqueness of each person
3. Uncovering the patient’s emotions about their dental health
4. Facilitating the development of heath, function, and esthetic goals
5. Exploring what is possible for them

Leadership Through Understanding

Why is this leadership? It is leadership because the practice leader is responsible for defining reality. The reality of what is important and how we act on those foundational beliefs. Those foundational beliefs that we call ‘values’ are the building blocks of our practice culture. That culture is defined by:

1. What is our WHY? Is our WHY what we reference to make our decisions and manage our practice?
2. What are the unique rules of behavior in this culture?
3. How do we spend our time and resources?
4. What defines success?

Knowing Your Patient

If practicing in a high trust relationship-based culture is what you desire, then knowing your patient is a cornerstone of your practice structure. It can act as a model for the rest of the critical relationships in and around your practice. If this is your culture, then all aspects of your practice are built around relationships.

Next are the relationships with and within your team. I was recently doing a presentation at a major dental meeting in which I was highlighting team roles and responsibilities. From the back of the room a dentist asked me how I attracted quality team members. My answer was simple:

“You have to be attractive to them.”

What I meant was that you have to study the marketplace and understand what the best candidates are seeking. Then, you actually have to deliver it.

To continue reading Part Two..…

How do you get to know your patient? 

There are three critical components to the incisal edge anatomy of anterior teeth. Understanding the function and esthetics of the pitch and two bevels is essential to creating an ideal patient result.

How can a clinician re-create the full anatomic form of the tooth in ceramics and composite? 

In my last blog on this topic, I discussed the dimensions, characterization, esthetics, restorative approach and challenge of mimicking ‘pitch‘ esthetics. Now, I’ll delve into mastering the bevels to create superior restorative results. Combining an esthetic pitch with functional bevels will ensure a smooth composite or ceramic outcome.

Components of Incisal Edge Anatomy Function and Esthetics: Bevels

The two bevels can be found on alternately the labial and the lingual of the transition zone between the pitch and these surfaces. They are often called the leading edge and the trailing edge.

Bevels

Dimensions: The bevels on both sides have a variable width. They can be between less than a millimeter to multiple millimeters long.

Characterization: The bevels lengthen in patients who grind their teeth in an excursive pathway pattern. Patients who parafunction edge to edge might eliminate the bevel. This makes it easier to shear enamel off on the labial or lingual side of the tooth. It also could result in chipping the edge enamel.

Function: The bevel is a transition zone to create smooth functional movement passing from excursive movements onto the pitch. Intercuspal stops on lower incisors are often on or gingival to the bevel.

Whether you are finalizing an equilibration, the occlusion on composites, or ceramics, perfecting anterior guidance is all about both pitch and bevel surfaces. These critical components are a great example of marrying form and function in your technique.

What is your restorative approach for recreating incisal edge anatomy? We’d love to hear from you in the comments! 

The incisal edge anatomy of anterior teeth is quite complex. This complexity is fundamental to the esthetics of the tooth, as well as the function of incisors. How do we re-create the full anatomic form of the tooth in ceramics and composite? 

Components of Incisal Edge Anatomy Function and Esthetics: Pitch

When the full anatomic form is not precisely recreated, this can lead to esthetic and functional challenges. To successfully mimic this form, the clinician can rely on three components of incisal edges (from a lateral perspective): 1 pitch and 2 bevels.

We can visualize the pitch as the flat top of the incisal edge.

Pitch

Dimensions: Labio-lingual width of at least 1mm that increases from attrition or parafunction in edge to edge position.

Characterization: Pitch is not always parallel to the horizon and its relative position is dependent on the inclination of the incisor. Incisors are inclined just a little bit further to the labial at the incisal edge and the pitch has an upward slant toward the lingual.

Esthetics: The tooth shape and inclination results in an incisal edge esthetic of thinner enamel at the labio-incisal junction. It also creates the highly desirable visual translucence. Leveling the pitch to the horizon can change light reflection which is critical to esthetics of the tooth.

Restorative Approach: Often in ceramics we create a pitch that is level to the horizon and has decreased width of the pitch. This can compromise the esthetics of the translucency, but that can be gained back using stains.

Challenge: The challenge with this shape change in ceramics is that patients often sit in edge to edge position during parafunction. Insufficient pitch width may result in the patient experiencing functional challenges, not finding a comfortable spot to rest and increased parafunctional movement.

I’ll expand on understanding the two bevels in my next incisal edge anatomy blog …

What aspects of incisal edge anatomy do you find most challenging? Let us know in the comments!

Pankey dentists have been instrumental in changing the face of dentistry and launching inspiring innovations that advanced patient care. This post is a continuation of my first blog on the history of Dr. Henry Tanner.

Developing the Tanner Appliance

Dr. Tanner always credited Dr. Ricketts for encouraging him and giving him permission to continue learning what patients were doing with their teeth. They were both using full arch lower appliances, although at that time, Henry simply called his a nightguard. For approximately 15 years, he made that nightguard on a single lower cast and then would adjust it in the mouth.

Some years later at The Pankey Institute, under Dr. John Anderson’s leadership, Dr. Tanner introduced his appliance to Dr. Parker Mahan. Dr. Mahan had a Ph.D. in anatomy, was a full time professor at the University of Florida Dental College, and was a world renowned authority on head and neck pain.  

How Dr. Tanner Changed Dentistry

With the full support and encouragement of Drs. Anderson and Mahan, Henry started teaching about his nightguard using mounted casts. Dr. Anderson initially named it a TANG (Tanner Appliance Night Guard).  

Dr. Tanner always said, “Don’t ever have anything named after you. Whenever people misuse it, then your name is attached.” Over the years, the Tanner appliance has become known as an anatomic appliance. It is extremely individualized, based on the patient’s unique joint, condyle, and tooth anatomy.

The goals are even bilateral centric relation contacts, non-interfering posteriors, and smooth anterior guidance. Dr. Tanner was always curious to see how little could be done to the person’s own unique occlusion to accomplish all those goals. Patient discovery and engagement are keys to Tanner appliance therapy.

Dr. Tanner passed away in 2003. His appliance and his life’s work live on.

Forty five years ago, in the fall of 1972, the first class at The Pankey Institute was held. It’s easy to forget how much things have changed in the world of dental continuing education. Read on for an enlightening reminder of how far dentistry has come in the last few decades … 

Pankey History: Dr. Henry Tanner

Dr. John Anderson and Dr. Loren Miller each had sold their private practices and dedicated their careers to the creation of the Institute. In 1974, Dr. Anderson asked Dr. Henry Tanner to be assistant director of education. Dr. Tanner had been head of fixed prosthodontics at USC School of Dentistry and had made several significant contributions to dentistry.  

Many years earlier, Dr. Tanner had rebuilt the occlusion of Dr. Anderson, who then described Henry as “the finest restorative dentist in the world.” Dr. Henry Tanner is most often associated with the development of the Tanner Appliance.  

Dr. Tanner vividly recalled the first time he made a lower full arch appliance for a woman who was having severe head and face pain. She and her husband went to the hospital emergency room and she was given morphine and Demerol, yet she was not having much relief.

During an emergency visit at his office, Dr. Tanner made an acrylic wafer, placed it directly in her mouth, had her touch it gently with her upper teeth, and asked her to mold it with her tongue. After the acrylic got rubbery, he took it out of her mouth, let it harden, and refined it. She was out of pain the next day.

Within weeks of that experience, Dr. Tanner met a well-recognized orthodontist, Dr. Bob Ricketts, who was taking laminagraphs (sectional x-rays) of his splint patients to monitor condylar position and bony healing in the joint.  

To be continued ...

One of the gifts of dentistry is that we get to drive our vision and create the practice that engages and fulfills us. There are really very few professions with such limitless possibilities.

If you dream about working three days a week, you can create that. If you want to work from 7-3 or 3-10 you can. Do you love doing endo procedures? Then you can do them. If you dislike doing pediatric dentistry, then you can choose to refer it all out.

How to Practice Dentistry in a Way That Fulfills You

There is no one way to practice dentistry. This is an incredible gift and for me makes dentistry one of the best professions. Having this amount of choice also comes with some challenges and responsibilities.

The first challenge is accepting the gift of choice. Dentistry is full of outside pressures that can drive how we practice if we choose to let them. These pressures may come from other members of our team, other dentists we know, insurance carriers, or our own beliefs.

Along with choice comes the responsibility for choices, their execution, and their outcomes. Creating the practice you dream about may not happen overnight. It will require a thoughtful plan and the commitment to execute it, but it is within your reach.

The place to start is to allow yourself to dream and dream big. Walk on the beach, find a quiet space, and just let go of the constraints of how things are now. Imagine what it would look like to practice dentistry and LOVE it.

As you imagine this preferred future, tap into your emotions. If you find yourself excited, energized, and propelled to action, then this is the path to start to walk down. Refrain from asking yourself “How” you will create it.

Once you have a vision for how you want to practice, now it is time to ask the “how” question and remember anything is possible. The question is what will it take to create it. Begin with a timeline and ask yourself how long from now you want to have the practice you just dreamed about.

On the right hand side of the timeline is that preferred future. On the left hand side is today and how things look today. Then work backwards from the future and place milestones in time and change along the way.

Remember, for everything you want, there will be something to give up or some cost, but it is possible!

How have you designed or wanted to design your dream practice? We’d love to hear from you in the comments!