Most of us are placing implant crowns, using screw retained crowns. If the crown needs to be recovered, or the screw needs to be changed or tightened, the restoration can be removed by accessing the screw through the screw channel.

One of the main advantages of screw-retained crowns is the ease of retrieval. I have discovered two ways to make retrieval easier for myself, which involve the colors of the Teflon tape and composite I use.

1. Now I have colored Teflon tape on hand, and when I place the screw, I put colored tape on top of the screw instead white tape. If I need to remove the composite, I more readily see my gray or yellow tape than I would white tape.
2. I also like to use a composite color that is not be an exact match with the implant crown. This way I can easily see the material to be removed to access the screw channel… if I need to remove the crown.

If you plan ahead to have colored Teflon tape on hand, you can do what I do. Teflon tape is available in multiple colors at Home Depot and other hardware stores.

Restorations are the foundation of a thriving dental practice because they keep you challenged and motivated while ensuring patient satisfaction. Indirect bonded anterior restorations provide patients with functional and aesthetic solutions to improve their smiles.

But “veneers” are more complicated than they seem when you see the finished product: bonded anterior restorations.

Before you decide on the type of restoration you are going to offer your patients in the anterior region, here are four questions you should be asking to get the most from your restorative process:

1. Can indirect bonded anterior restorations strengthen worn-down, eroded, or chipped teeth?
2. Should teeth be whitened before they are veneered?
3. Should endodontically treated teeth be veneered?
4. Are crowns stronger than veneers?

If you are hungry for more guidance on indirect bonded anterior restorations, check out my upcoming course at Pankey Online. On Friday, August 20th, 2021, from 2-4 pm ET, I will be hosting a live, 2-hour virtual course, “Indirect Bonded Anterior Restorations.” You can easily register for my course, which provides 2 CE credits, at Pankey Online.

Join me as we discuss useful concepts like three-dimensional functional and esthetic mock-ups, provisional fabrication, preparation design for adhesive restorations, and more. See you there!

As a small business owner emerging from the Covid crisis, one of the issues we face is how to manage employee compensation in a fair and open manner. Are we paying our employees a fair wage for what they do in the demographic area that we live in? Often it is not possible to know what the competition is paying.

In our current job market, skilled labor knows that they can be tough negotiators. Under current National Labor Relations Act rules employees have the right to discuss wages, hours and working conditions with others. Pay discrepancies can result in potential claims of discrimination and resentment. A mix of new hires and old hands, in particular, may lead to conflict about wages.

Your Wage Budget & Scenario Analysis

One way to address this as an owner is to create a spreadsheet that establishes the range of wages you are able to pay for various positions based on your requirements and your budget. It might look something like this:

In my case, I need to know not only what I am paying and whether I am competitive to get the best talent. I also need to know how any changes will impact my overall budget. As I am considering changes in my current employee wages and what I can pay a new hire, I need to know my overall business finances.

I also need to not manage my practice revenue to cover the luxury items I want in my personal life but instead to grow and sustain my business. I need a business growth mindset plus the attitude that Dr. L.D. Pankey promoted when he admonished dentists to learn to live on less than they make. Our teams make it possible to be in business. People come first. We’re in a people business.

Professional Guidance & Standards

My state professional association conducts a survey of offices every few years that provides a reasonably accurate picture of wages and benefits based on a number of demographic variables. That information, along with discussion of this issue with my peers, provides me with an idea of what the range of wages should be in my area.

My industry ideal is to keep total overhead for staff as close to 25% as possible, but in today’s economy this is becoming more difficult. I have found it helpful to define the market value of the various positions in the business and to understand the difference between the team members who produce income and those who do not.

Ask & Answer for Yourself a Few Questions

Where are your wages relative to your peer group? Are you underpaying, or overpaying, some of your people, and if so, what will you do about it? Where are your wages with respect to your budget and to what business analysis considers Ideal?

Something Most Dentists Don’t Do

You can take the information from your spreadsheet and share what you have learned with your team on an individual basis.

Each person needs to know that there is a range of pay for what they bring to your business. When they reach the top of the range, often due to longevity, that is all you can offer in wages. You might consider offering additional employee benefits, for example, additional vacation time. But know that what you offer will very likely be shared with everyone else.

Your wage budget worksheet allows you to develop an open and fair discussion of compensation. It helps remove much of the emotion that often gets in the way when employer and employee seek to justify levels of compensation. Your team members need to know you respect and value them, and to grasp that to remain in business there must be a profit and a budget for the business that makes sense for all concerned.

Relationship-Based Dental Practices Have an Advantage

Although recent news and chat forums indicate wages are rising for dental workers and this is putting pressure on dentists to increase their fees, we have much goodwill we can use to counterbalance this. Employees are not apt to jump ship when they like the environment in which they work…where their work is respected, their work is meaningful, they enjoy their co-workers, and solutions are found to reduce stress.

Dentists, who are truly relationship-based in their philosophy of dental practice, offer a totally different working environment than the many dental practices, in which employees describe their workplace as toxic. You can leverage the goodwill of your team members to help recruit the right new employees and stay in budget.

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In the comments below, I’d love to hear how other private, fee-for-service dental practices are currently mindfully managing hiring and wages.

The question of whether it is better to have a rough or smooth tooth preparation for indirect restorations pops up from time to time, and dentists relate to me they have heard conflicting opinions.

I go to the research literature to become better informed when questions arise, and this is one question research has answered convincingly for me.

What is the impact of texture on the predictability of your restorations?

When we think about the surface texture of a tooth preparation, there are two considerations.

1. How does the surface texture have an impact on bond strength or retention of an adhesively placed restoration? Do coarser surface textures on preps increase bond strength, or is it exactly the opposite?
2. How does the surface texture impact the accuracy of a VPS or Polyether impression and therefore the fit of the restoration?

It turns out that smoother is better.

If you go to the literature and look up the research studies in PubMed, you will find there is a high correlation between high bond strength and extremely smooth surface texture. To achieve an extremely smooth surface texture, multiple studies used carbide burs that are in the same shape that we use in doing crown and veneer preparations.

The other piece of the puzzle (the second consideration) has to do with the contact angle of VPS or Polyether impression materials and the tooth preparation. The smoother the preparation surface is, the more accurate the impression will be. The more accurate the impression is, the more accurate the die will be. And the more accurate the die is, the more accurate the fit of the final restoration will be.

So, in both categories, bond strength for adhesives and accuracy of physical impressions, smoother preps win over coarser preps.

Mastery sits atop L. D. Pankey’s Ladder of Competency. The question is how does one achieve mastery? Once again it has been reduced to “Just Do It.” But there is more science.

In his 1953 paper, The Achievement Motive, Harvard psychologist David McClelland wrote an original thesis about mastery. Psychologists Deci and Ryan (authors of Self-Determination and Intrinsic Motivation in Human Behavior) acknowledged that this thesis may have described an intrinsic driver even more important than autonomy. They called it competence, but it is now known as mastery.

The pursuit of mastery has been the subject of numerous scholars and authors from Theresa Amabile and Robert Greene to George Leonard. Most agree that mastery is the desire to get better at what we do. It is the need to continually get better, to improve, and to make progress. It is the royal road to growth and flourishing and the opposite of languishing and drudgery (the low rung on Pankey’s Ladder of Competency).

The Process/Progress of Mastery Is Pleasurable

Working toward worthy goals is pleasurable. Making progress produces the neuro-chemical dopamine. According to Dan Pink, author of the popular book Drive, the single biggest motivator by far, is making progress in meaningful work.

At my lowest point in dentistry, I felt stuck…hopeless. My work had lost its meaning. Today we call that burnout. Remember those Thursday mornings I mentioned in Part 1 of How to Move Toward Independence in Dentistry? Those Thursday mornings turned on the light of hope.

We need the freedom to chase mastery. That freedom comes from autonomy. Without the intrinsic driver of autonomy, it is difficult to sustain the drive necessary to achieve mastery. This is based on our biology, not just some story, fairy tale, or business myth.

So, after scheduling Thursday mornings to practice autonomously, applying the Pankey Institute lessons I needed to learn and make second nature, I slowly put the complex elements of comprehensive, relationship-based dentistry together. I started with the comprehensive examination and built on that by learning all the components from mounting of models to the nuances of advanced occlusion. It took time…but driven by dopamine and progress, slowly I was installing my model practice.

Behavioral Skills and Technical Skills Are Both Important

In time I came to realize that learning the softer behavioral skills were just as important as the technical, so I learned about case presentation. Through the years I learned new skills like digital photography and PowerPoint. This is the essence of mastery. I am retired now. Looking back, I see how that the moment Dr. Becker suggested implementing the “Pankey Morning” changed my life.

There Is a Way to Enjoy Dentistry

Today things are different than when I was a young. There is pressure to go right into corporate dentistry or practice in a way that is built on extrinsic motivators. Many of the newer models of practice are an assault on autonomy, and many dentists don’t realize the root of their unhappiness for years.

My new book, The Porch, is a fable about a dentist who is losing his autonomy and breaks down. By finding a mentor and keeping his eyes on the ultimate prize, he goes from despair to hope. The book provides lessons the young dentist learns along a path of mastery, with the leadership and support of other colleagues.

Pankey Institute instructors, mentors, and colleagues inspired and encouraged my personal path. As I recall, many of them started on their personal fee-for-service journey, like I did, with focus on changing and mastering a new approach to patient examination, education, and leadership — one new patient at a time, one morning per week.

Our constantly growing Pankey Institute community has stayed “on the porch” of conversation, like the Stoic philosophers under the stoa, to grow in shared wisdom over 50 years. This wisdom is never outdated, even as dentistry has changed. There is a way to enjoy dentistry. My mission is to keep writing and awakening hope.