We are “all in” on getting ready for our office to re-open. We have been in dialogue with our team members, reviewed our cleaning, asepsis, OSHA protocols, and worked out client and staff management protocols that follow the ADA guidelines. We are ready to go! However, our governor may prevent us from starting for another month. If that happens, we will have lost a full three months of production – one quarter of the year. 

We can never regain that lost revenue. Like the car salesman who does not close the sale, the money that was going to pay our fees is now gone forever as it has been spent somewhere else. If you want to understand a bit more about the mathematics of loss, take a moment to read this letter from Steve Blumenthal. The letter is old, but the math still makes sense and it is not pretty.  

“The New Normal” 

Like many of you, we have been “Zooming” into a variety of web-based CE on how to manage the new normal. The new normal to us looks like less productivity and higher overhead. The new normal also looks to us like a time when our clients and staff will feel a sense of increased vulnerability, so it is imperative that everything we do at every touchpoint is focused on active listening, positive messaging, and mutual respect.  

The Question of Fees 

This leads to the question of fees. Some presenters are suggesting adding charges for PPE or raising fees in general. Our opinion is that, as a nation, we are about to enter a period of deflation. If our clients are worried about maintaining their jobs, they are not going to spend discretionary dollars. We are very unlikely to see a V-shaped recovery. Our government has poured a great deal of money into the economic system, but fearful people will not spend if they are not sure of a paycheck.  

Most of us will have to eat the added overhead in our practices. In fact, many practices will look at staff costs and decide to run with less people. You can count on insurance carriers to use the pandemic to push on dentistry to accept lower reimbursement.  

Our Plan 

We know we will lose production until we refine our new systems. We are asking our team members to consider flex time until we can ramp up and have everyone working effectively. We are asking team members to multi-task so we can avoid adding extra people for the increase in sanitation needs. We are revamping scheduling and hours to get maximum productivity with patient flow that will be less than the old normal.  

We have mapped out projected production and can meet reasonable goals under the new model with no fee increase for now. We plan to hold the line for four months and then we will have a fee increase. How much? We do not know yet, but we project at least 3 – 5%. We believe that amount will be accepted by clients and will cover most of the cost of increased overhead. We do not foresee the fee increase dropping the bottom line. If you want to share what you are doing, feel free to do so in the comments section of this blog. 

SpeedCEM Plus is a dual-cure self-adhesive resin cement from Ivoclar that has been designed to be used with restorations that have inherent mechanical retention. It can be used for most materials – all-metal restorations, zirconia oxide ceramics, or something in the lithium disilicate category. The material will fully pull MRIs on its own, but it can also be light-cured. It has great esthetics, low technique sensitivity from the standpoint of using the material, and great bond strength. It is easily cleaned up. 

Prepping the Internal Surface of the Restoration 

Oxide-based ceramic restorations are etched with air abrasion. Your laboratory can do this, or you can use between 30 and 50-micron aluminum oxide to air abrade the intaglio of the restoration. Confirm with your lab if they are going to be doing this. 

The internal surface of lithium disilicate based restorations is etched using chemistry. You can use hydrochloric acid at 5% for no more than 20 seconds, or you can use an Ivoclar Vivadent product called Monobond Etch & Prime for 60 seconds.  

If you try in the restoration after it has been etched, as I like to do, then the restoration will need to be cleaned again before it is bonded. For this cleaning purpose, I use Ivoclar Vivadent’s Ivoclean. It’s a phosphate-free restorative cleaning material that can be used on metal, oxide-based ceramic materials, and on lithium disilicate materials. I simply vigorously shake the bottle and apply Ivoclean for 20 to 30 seconds, rinse the restoration and dry it. I recommend using a clean air source for drying such as an Adec airline on your unit. 

If you are going to use metal ceramics or lithium disilicate, you now need to condition the inside of the restorative material. I use the product Monobond Plus, which is appropriate for all kinds of materials.  

If you are working with zirconia or an oxide-based ceramic, one of the advantages of SpeedCEM Plus is you do not have to do anything to the inside of the restoration other than the air abrasion and cleaning because the chemistry in the SpeedCEM Plus will prime or condition the inside of the zirconia restoration.  

Prepping the Prepared Tooth 

With SpeedCEM Plus, we do not need to do anything to the tooth prior to cementation other than cleaning the tooth. I like to clean the prepared tooth with light air abrasion and apply a 2% chlorhexidine solution to the prep and clean the tooth with a bristle brush in a slow-speed handpiece. 

SpeedCEM Plus Application & Cure 

After cleaning the prep, you can load the restoration with SpeedCEM Plus and seat the restoration. SpeedCEM Plus comes with a mixing tip through which you express the adhesive.  

You now have two choices. You can hold the restoration in place with firm pressure and allow it to go to its self-cure mode which intraorally takes approximately 3 minutes. Alternatively, you can use your curing light to speed up the process.  

After I seat the restoration, I like to check the margins with an explore to make sure I have not had a mis-seat and then I pick up my curing light and, at a distance of 1 to 10 mm, I cure for one second at each line angle. We call this the quarter technique… mesial buccal one second, distal buccal one second, mesial lingual one second and distal lingual one second. I can now quickly go in and clean up all excess cement, making sure I get excess cement out of the interproximals. It’s important to cure on the line angles, not just buccal and lingual, or you will leave a lot of material that doesn’t reach the gel phase interproximally.     

Once all the excess material is cleaned off, I cover all of the margins with an oxygen barrier, and I do a 20-second cure on each of the four line angles using the quarter technique. The patient is good to go once you check the occlusion. 

Notes 

• SpeedCEM Plus comes in three shades 
• It is designed to be capped in the refrigerator. Never remove the used mixing tip and put a new empty tip on as this would leave the base and catalyst at the ends of the barrel exposed to air. You can either replace the used mixing tip with the original manufacturer’s cap or leave the used mixing tip on and disinfect it just like you wipe your light-curing unit. I recommend you do the latter, as it decreases the risk of contaminating the resin and initiating the self-cure process in the barrel. 
• Because the material is so versatile, you also can use it for placing your posts. 

More than 31% of solo practicing dentists today are 55 years or older. Since most dentists have traditionally retired between 60 and 69, retirement is a “hot” topic.

Future Financial Need

Goal setters who have planned for retirement since the beginning have accumulated five times what a non-planner has saved. Yet, baby boomers (now mid 60’s to 70’s) have reinvented each phase of their lives, never matching what has been customary. An ADA survey indicates dentists save 10.6% of their income which is below the federal limit of 15% contributions to a qualified pension fund.

Financial advisors think you will need from 70 to 90% of your current net income in retirement. The average dental net in 2019 was nearly $200K. In retirement planning, eighty percent of that is $160K, which is $13,350 a month. If you retire at age 60 and live another thirty years, you will need $4.8M from interest and savings.

Retirement Choices for Today’s Boomers

The figures are staggering for the slightly unprepared. What are the choices for today’s boomer dentist? Sale? Partnership? Associateship? Retire as you go? Or, will you up your game plan for 5 more years? Let’s investigate.

Sale: A sale is currently worth about 24 months of net income which is then taxed. Beware. A sale is final. You are no longer a dentist in that location. There is no going back. The book is closed.

Partnership: Partnerships in retirement have their own pros and cons. By reviewing what motivated you to enter the profession, you may find independence and freedom on your list. Selling half your practice to an unknown partner means you have surrendered your freedom and half your net income in exchange for about nine months of net income. The staff will still look to you for leadership.

Associateship: Becoming an associate after thirty years of private practice could be successful if you have the qualities to be an employee. Will you be happy doing dentistry for someone else? Do you have the qualities to be a team player under someone else’s leadership and rules?

Continue Your Own Practice by Retiring as You Go: Continuing to practice beyond the average retirement age is a viable alternative. The real advantages to keeping your own practice viable are the continued net income, ability to deduct expenses such as continuing education and a leased car, and the psychological rewards of feeling needed, serving others, and your earned status in the community.

Continuing your own practice can be done on your own terms. You can design your ideal practice days, plan your continuing education around travel adventures, and attract staff to work your schedule. You may want to work three days a week for three weeks and take the fourth week off. If you can continue to work on your own terms and have a substantial income that does not require using your retirement funds until you choose, count the advantages and your blessings.

Continue Your Own Practice by Upping Your Game: Another viable choice is to “Up Your Game” and actually make an extra $2M by increasing net in a five-year plan. This can cause a $900K increase in the eventual sale price. We have a number of very pleased retired dentists who upped their game in their 60’s. They can’t believe how much more enjoyable practice is again.

Upping your game means increasing your dental skills and your treatment offerings, installing strong systems of block booking to produce more in fewer days, solid sales conversations for an increased level of patient care, and having an accountable accomplished team marching with you. Because you have upped your skills and are focused, you can actually take more time away as you increase your net. 

Which Choice Is Right for You?

Examine your financial needs. Examine why you enjoy dental practice? Examine your options and spend time thinking about which retirement option feels most comfortable to you. We can help. Many of our clients have chosen to stay part of dentistry, and we have observed that when dentists keep up with continuing education and become skilled at working with new materials and techniques, they gain more than an enhanced income stream. They feel a rebirth and rejuvenation about their profession.