Trust is a central facet of human interaction, one that cannot be ignored in a dental or business setting. This blog reviews some interesting concepts on trust from Oxford professor Rachel Botsman: 

Trust: Known and Unknown

Botsman is a thought leader and significant contributor to the current conversation surrounding the role of trust in our personal and business relationships as well as our culture. She says that trust lives in the unique tension between our hopes and fears. It is about vulnerability and expectations.

Trust acts as the bridge between the known, where we are comfortable, and the unknown, where we are fearful. She defines trust as, “a confident relationship to the unknown.”

Similarly, when we enter into a relationship with a patient, there is a great deal unknown to them concerning their dental condition. They don’t necessarily sense what is required to establish good health, function, and esthetics.

A Relationship Strategy

According to Botsman, in developing our strategy of building high trust relationships, our goal should not be to build more trust. Our goal should be to become more trustworthy.

The established science of trustworthiness says that it requires high levels of competence, reliability, benevolence, and integrity in our life and practice to be present and experienced by others. Integrity, or aligning our intentions with our actions, is the most important.  

That same science says that real trust takes time and friction, at least some minimal friction, to establish. When a relationship is established seamlessly and instantly, there isn’t even the time and opportunity to ask the question: “Should I trust this person with something that is important to me?” That is the minimum amount of friction required.

Many organizations and a significant amount of behavioral research conclude that the strongest relationships are those that have experienced a problem and found a way to reconcile the issue. In other words, friction strengthened the relationship through solving the problem.

Have you listened to or read anything by Rachel Botsman? Join the conversation below … !

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

QuickSplint to Improve the Patient Experience

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

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

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

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

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

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

We don’t always want to take an Uber across the Rickenbacker Causeway into Miami for a day out. If you’re visiting Key Biscayne before or after a Pankey CE course, why not explore more of the island and get to know this beautiful vacation destination?

You can walk the entire length of the Key – from Calusa Park to Bill Baggs Cape Florida State Park – in under an hour if you’re particularly industrious. It’s a fascinating, self-contained place that manages to distinguish itself from the intensity of Miami. It’s also a lush location for beach lounging, ocean wildlife sightseeing, unique food, golfing, and relaxation.

So what’s the best way to see Key Biscayne? By foot can be a bit too exhausting, so why not try a bike …

Exploring the Key by Bike

Key Biscayne is officially a ‘bike friendly’ community. Because it’s such a small area, cars are less of a disturbance. You can now pick up a bike all over the Key for a refreshing ride about town. Just download the Lime bike share app on either Google Play or the App Store and get to pedaling.

Lime bikes are much more convenient than most public bike systems since they have no official docking station you have to show up at. Use the app to search for a bike nearby and you’re good to go.

After multiple days of learning at the Pankey Institute, a bike ride outside is just what most us need to digest it all. Cover some serious distance and stop at our favorite food spots along your path. Wind through neighborhoods with buildings old and new, extravagant mansions and humble family homes. Catch a glimpse of the bay and inhale a whiff of salt air.

When you’re ready for a rest, you can park your bike wherever you want to end up.

What’s your favorite way to sightsee? 

Creating amazing provisionals primes the patient for a positive treatment experience and ensures they’ll be content even before the final veneers. Read on for the last post in our four-part shrink wrap provisionals fabrication series:

Checking Occlusion and Polishing Shrink Wrap Provisionals

After cleaning off most of the excess from the provisional with a universal scaler, extra fine mosquito diamond, and a brownie, use the same diamond to open the linguo-gingival embrasures with the intent that the patient should be able to pass floss through them. This also keeps the tissue as healthy as possible for the seat later on.

Now that you’ve done all your flash trim, you should check the protrusive and right and left excursive occlusion, making sure you have even marks and no fremitus. Check intercuspal position to ensure you have no fremitus there as well, either lying back or with the patient in the alert feeding position.

With everything trimmed and ready to go, the last step is simply to polish. You can use the Brasseler Featherlite porcelain polishing system running in a latch handpiece. Utilize the first of three polishers at about 15,000 RMP, then move to the second polisher at about 10,000 RPM. They can be run at a higher speed, but you’ll get way fewer uses out of the polishers. Finally, run the last of the three polishers at about 7,000 RPM.

If you notice a porosity after cleaning out the residue from the polishing, you can use a Venus Diamond flowable that matches the esthetics of the bisacryl exactly. Fill the void by manipulating the side of the explorer to drag away excess and feather it out. Then simply light cure so that food doesn’t pack into the void.

The final step of this shrink wrap technique is to use Dialite polishing paste from Brasseler in an impregnated bristle brush to create a perfectly smooth finish. The entire process of provisionalization should take no more than about fifteen minutes.

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

Utilizing the shrink wrap technique for predictable veneers necessitates careful attention to materials selection and silicone matrix creation. Once you have created the matrix, cleaned the preps, and fully seated the matrix, you can use a 2 x 2 soaked thoroughly in rubbing alcohol to wipe across and remove the air-inhibited layer.

Cleaning Up the Veneers Preparation

Because of the matrix with the silicone gasket, almost all of the excess matrix material should flake off with a universal scaler. That’s why this technique works perfectly for preps with equigingival or supragingival margins. It works less well if you have a subgingival margin because the gasket separates the silicone right at the level of the existing free gingival margin.

On the lingual, you will have a very thin film of excess material sitting over the unprepared portion of the tooth. You can peel it off using the scaler. These provisionals are not easy to pull off or dislodge from the teeth. That means you don’t have to be cautious. The material will separate as if it has been perforated right where the margin was.

After the use of a universal scaler, you can check all the margins. You’ll realize you have virtually no excess. You can then utilize an extra fine mosquito diamond at 20,000 rpm dry in the speed reduction Brasseler NSK high speed attachment. You should open the facial gingival embrasures so the patient can get floss through them. This will lead to healthy gingival tissues that aren’t inflamed on the day of the seat.

Now switch to a brownie silicone point running dry at 10,000 to 20,000 rpm. A brownie at this speed will cut any kind of resin to create a perfect infinity margin right where the lingual reduction is on the preparations and remove any excess.

What common provisionals technique do you prefer for veneers? To be continued … 

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

Provisionals are an important part of veneers fabrication that requires just as much care and diligence as the final restoration. After acquiring diagnostic and lab records and fabricating a silicone matrix, the next step is to clean the preps with a dilute solution of 2% chlorhexidine prep scrub. Use a syringe tip with a fuzzy end for optimal brushing.

Cleaning the Veneer Preps and Loading the Matrix

The latter process ensures you start off with clean, bacteria-free preps. Rinse off the chlorhexidine and thoroughly dry the preps. With this technique you should spot-etch utilizing 35% phosphoric acid for a 3mm diameter spot on the facial or labial of the teeth.

Keep the etch far away from the margins and interproximals. Leave it for 30 seconds, rinse off, and vigorously dry the preparations. You can use an air/water syringe because a little contamination is fine.

You should then apply GLUMA from Kulzer to every prep, which is a combination of antimicrobial glutaraldehyde and HEMA that prevents tooth sensitivity. The GLUMA excess is dried with cotton to prevent it from getting in saliva or mucous membranes.

Now that teeth are ready, you can load the silicone matrix with a bisacryl material. Load the matrix by moving back and forth along the incisal edge and adding layers to minimize the incorporation of air bubbles. Fully seat it. One of the tricks with this matrix is the very flat occlusal table so you can apply even pressure. Additionally, adequate thickness of the silicone provides rigidity and accuracy with less trim needed.

Let the material stay in the mouth for the full set time, which is a little over four minutes. At that point, remove the matrix for completely hard bisacryl on the teeth.

To be continued …

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

Of all the methods commonly used for veneer provisionalization, my favorite has to be the shrink wrap technique. I love it and use it all the time because in my opinion it is the easiest and most predictable method.

The term ‘shrink wrap’ comes from allowing polymerization shrinkage of the material to lock bisacryl onto the preparation. The main advantage of this approach is that it keeps veneer provisionals firmly secured until the final restoration can be placed.

Here’s my take on utilizing this technique in the dental practice:

Predictable Veneers with Shrink Wrap Provisionals

The first step of shrink wrap provisionals is to prepare the teeth. Let’s imagine you are dealing with a patient who experienced trauma such as breaking their teeth in a bicycle accident.

Before beginning the technique, make sure you have all the diagnostic records you need, including all prep records for the lab: facebow, opposing model, final impressions (maybe more than one) with good flash, etc. Once you provisionalize the teeth, it won’t be easy to get access to the preps again.

One of the essential parts of a shrink wrap provisional technique is fabrication of a silicone matrix with a silicone gasket to separate the excess. You should begin with a solid model either of the teeth before they are prepared or of the wax-up. You can carve a 1 mm deep trench into the wax-up by using the cleoid end of a cleoid/discoid.

Put the sharp pointy end right on the free gingival margin of the gingival of the tooth on the model to carve. You can even go a little deeper in the interproximals. Now take that model and fabricate a two stage silicone matrix.

First, create a putty matrix and trim it. Then, load the putty with the light body of the same impression system, reseat on the model, allow it to achieve a full set, and trim. Now you are ready to go to the patient and use lip retractors. Remember to add a little vaseline or lubricant to the lips for comfort.

At this point, I like to use the OptraGate from Ivoclar Vivadent for a latex free retraction device that can handle anything in the anterior. I will have it in during preparation and for impressions so I don’t have to hold the lip out of the way.

To be continued …

The Shrink Wrap Technique is taught in our hands on course Excellence in Bonded Porcelain.

Small group learning is the linchpin of lifelong professional satisfaction. 

My partner Nancy and I are excited to be the co-directors of Pankey Learning Groups (PLGs) at this time in the history of the Pankey Institute. Small group learning has always been one of our greatest joys.

It was in small groups that we really cemented our learning together. We had a chance to ask the professional and personal questions we might not have in other less safe environments without people who “understood.” We shared in good feedback with mentors and peers. Discussions were honest and helped us see others and ourselves more clearly. And we made dear friends for a lifetime.

So when we were asked to do this job three years ago, it was easy to accept the challenge. We did our best to build upon the program that Mark Murphy had initiated for us. With lots of hard work from PLG hosts, facilitators, our alumni that donated cases and workshop material, and especially a stellar in-house team, we feel good about where we are today. 

Pankey Learning Groups: Providing Support & Education Opportunities

We are really excited about what the future holds. With Dr. Lee Ann Brady on board contributing her vast experience in educational development, we all have a better sense of how PLGs can support the other components of the Pankey Institute. PLGs will now support the Essentials series, focus courses, and on-the-road courses like Worn Dentition and Pankey On the Podium.

We have a fantastic line-up of new modules. Treating doctors are interviewed and provide additional insight and understanding. We are also developing a selection of mini-modules. These topics include sleep medicine, practice management issues, and behavior.

In response to PLG requests, we are getting increasingly clear about how we can support our independent model (eight three-hour modules) and our facilitated model (two sixteen-hour weekend workshops) as well as how we can combine them with other educational offerings from Pankey. We feel this is consistent with the Pankey Philosophy to individualize our offerings for each PLG within our overall educational framework.

We are planning opportunities to support our hosts, facilitators, and ambassadors by developing resources and training to optimize the PLG educational experience. There has never been a better or more exciting time to supplement your professional growth by participating in a Pankey Learning Group!

Listening is a skill everyone likes to talk about but very few actually know how to enact. It’s more challenging than we might think to really shut our mouths and pay attention without constantly interrupting or adding our two cents.

In my last blog, I talked about offering an empty presence and letting the person finish their story. Here, I cover other important listening skills. We should all make the effort to speak less and hear more.

Become a Truly Great Listener

Listen for Their Heart

Listen for the feelings behind the words. Can you hear voice fluctuations? Can you read their eyes? Feelings of regret, fear, grief, hope, etc.

Using the balloon symbolism, I picture a red balloon filling with their emotions as I listen for feelings. There is no higher form of communication than heartfelt, empathetic listening. The balloon symbolism may feel silly, but it will help.

You cannot be heard until the patient’s emotional bubble is deflated through your quiet confidence and empathetic understanding.

Ask Permission to Go Forward

When you ask for and receive permission to offer advice, you are much more likely to be heard. This is truly one of the most intuitive questions you can ever ask and does wonders for building rapport: “May I give you some initial thoughts?”  or “May I have permission to consider what you have told me and study possible solutions?” 

Once a person has given you permission, they are more likely to become a partner in solutions. 

There is no greater gift of healing, expression of love and builder of self-esteem we can offer those special people we care about most, including our family, friends, patients, co-workers, and community, than listening. Everyone wants to be heard.

How do you practice listening skills? Let us know in the comments section below!

Dr. Pankey had an advantage most of us do not that made him a world-class listener. Often labeled a disability, Dr. Pankey was hard of hearing. Because of this, he had to learn how to listen intently to his patients.

Dr. Pankey learned to listen for feeling over content. Listening is a skill that can be developed and improved. It requires intention and attention. One must practice! Here are a few tips that help:

Actionable Skills to Become a World-Class Listener

Offer Your Empty Presence

Most important of all is the intent to be present. Be here, nowhere else. Never enter a room without taking a deep belly breath to quiet the sympathetic, judgmental lizard brain and enhance the empathetic brain.

Empty presence is being fully available for the patient with no agenda, no busy talk going on in your mind, no judgment about what is said, no mental correcting or explaining chatter going on in your head for when you get a chance to talk.

I like to imagine an empty white balloon completely devoid of anything. My objective is to simply let the person fill it with their own thoughts and feelings. Really focus on what they say and how they say it and especially the feelings behind it. You are a gatherer of their information, not an explainer, corrector, teacher, or judge.

Let the Person Finish Their Story Without Interruption

Take a deep belly breath again once they have gone silent. What they just told you is simply what they first told you. There is probably more. When a person has finished their story, the silent period is when they are understanding what they just said.

Silently offer your open heart with compassion, allowing them time to spill out everything they need to say. Silently count to 10 before speaking, then use simple encouragements: “Is there anything more,” “Yes, I understand,” “I’m glad to know that,”  “I’m sorry to hear that,” or “Tell me more.”

To be continued …