Using Air Abrasion for Composite Repair

March 28, 2022 Lee Ann Brady DMD

A while ago, I had the opportunity to repair a small bubble in an old composite restoration, and I got to thinking you might like to know how I use air abrasion to do this type of repair.

I don’t know how many times you see this, but I frequently see small holes in old composite restorations. In many cases, the margins look good. Everything looks good about the restoration except where there was an air bubble when the composite was placed and now there is a little hole on the occlusal surface. Food can get trapped and staining can occur in the hole, but the hole doesn’t descend into the tooth. And sometimes I see a little gap on the margin of an old composite with staining or early decay. In both cases, I don’t want to remove the entire restoration.

I use a lot of air abrasion in my practice, and in particular, I find it is wonderful for repairing old composite. I have the EtchMaster® from Groman. It’s a little handpiece that is super easy and convenient. It makes using air abrasion chairside something you will want to do every day.

Use 50-micron aluminum oxide air abrasion to clean out the stain, etch the old composite, and etch the tooth. If any tooth structure is to be etched, this air abrasion is a replacement for phosphoric acid. So, in one easy step, you have prepped the tooth and the composite. A plus of this technique is that local anesthetic is not needed if the hole does not extend into the tooth.

Now you can go in and use your dentin adhesive and replace your repair composite. Today, dentin adhesives contain MDP or PMMA which is the chemistry we need for the new composite to bond to the old composite. If I were to repair a composite restoration with a handpiece and a burr, I would not get the same bonded interface between the new resin and the old resin.

For both ease, patient comfort, and the best bond, I choose to treat previously polymerized resin with air abrasion and then some sort of resin that contains either MDP or PMMA.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Touchstones? Which do you choose?

March 25, 2022 Sheri Kay RDH

It seems we all have things I call “touchstones” that we keep around to help us feel grounded and to remind us of who we are. We also have items around us simply because they make us smile.

A good friend of mine used to talk about having a garage sale for her thoughts and behaviors, and I love that idea! My own experience has taught me that the people, belongings, and structures I surround myself with have an enormous impact on my thoughts, feelings, and behaviors.

A few years back, I downsized to an 800 square foot mountain home in Black Mountain, North Carolina that I lovingly call the “Tiny Mansion.” When I made this move, I got rid of so much stuff! I literally touched everything I owned and made a thoughtful decision on what would stay and what would go.

I found that I kept things that connected me in a concrete way to different people, places, and experiences that had special meaning. I let go of lots and lots of things that were not essential tools as well as things that were related to people, memories, or parts of my life I was ready to release. I’ve learned that growth is not only about adding to our lives, but maybe even more importantly, it’s about letting go of that which no longer serves us.

Now what I do is intentionally surround myself with what encourages me to be the person I want to be, and to feel the way I want to feel when I’m in the world. All the books I have on my shelf are purposefully there. I scan through them on a regular basis to make sure they are still books that have special meaning. Another habit I’ve created is to get rid of something every time I make a purchase. Buy shoes…get rid of shoes. Buy a shirt…get rid of 2 shirts. It’s a deliberate choice designed to keep me from becoming overwhelmed by a whole bunch of stuff that I no longer want or need.

To live that intentionally was new to me when I decided to make my move to the Tiny Mansion. Necessity drove me to become highly selective about what I would see and touch in my day-to- day world. This idea became part of my updated philosophy…my living, thinking approach to curating positive things, people, actions, and experiences in my life. I am in a dynamic process of becoming my best self (almost) every day.

What inspired me to share this is the realization that I was smiling when I poured a smoothie in one of my Pankey cups. This particular piece of my “Pankey merch” collection was a gift from Dr. Lee Brady, and I love (on many levels) what it means to me.

I feel absolutely uplifted by being surrounded by things I love. The ability to see and touch these “stones” is a positive force in my life. I wonder what you might surround yourself with that is intentional and has meaning for you. I also wonder what you might be ready to let go of. Which things do you choose to be visible touchstones in your life?

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Sheri Kay RDH

Sheri Kay started her career in dentistry as a dental assistant for an “under one roof” practice in 1980. The years quickly flew by as Sheri worked her way from one position to the next learning everything possible about the different opportunities and roles available in an office. As much as she loved dentistry … something was always missing. In 1994, after Sheri graduated from hygiene school, her entire world changed when she was introduced to the Pankey Philosophy of Care. What came next for Sheri was an intense desire to help other dental professionals learn how they could positively influence the health and profitability of their own practices. By 2012, Sheri was working full time as a Dental Practice Coach and has since worked with over 300 practices across the country. Owning SKY Dental Practice Dental Coaching is more of a lifestyle than a job, as Sheri thrives on the strong relationships that she develops with her clients. She enjoys speaking at state meetings, facilitating with Study Clubs and of course, coaching with her practices.

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The Wonder of Relevant Examples – Part 2

March 21, 2022 Richard Green DDS MBA

One evening I was seated next to a new acquaintance at a dinner party. As we began the conversation, I learned Bob was a retired CFO of a manufacturing company with $250 million in sales. He had traveled extensively and had had many experiences in dental offices.

In our conversation, Bob discovered I was a dentist teaching at The Pankey Institute. I thought I would move the conversation off of dentistry and have the opportunity to climb into the mind of a CFO of a $250 million dollar company, so when he asked what I taught, I responded with “I teach Finance.” He looked surprised and a bit disinterested, but he said, “You know, the thing that impresses me most, about dentists, is how quickly they make decisions.”

Trying to find the compliment in the statement, he had just made and hoping he thought dentists to be of high intelligence, I queried, “Quick decisions?” He went on to tell me, and sometimes show me between bites of food, the crowns I had already noticed. He said, “It always impressed me, when I went into the dental office with a broken tooth, how the dentist would have a quick look around and then tell me I needed a crown. Sometimes he was ready to do it on the spot!”

Other things had come out in our conversation. He was an accomplished golfer with a six handicap. He had three homes, and each home had an identical set of golf clubs. All were recently updated, matched, swing-weighted custom sets. My mind was spinning as I thought about the gap between those matched sets of clubs and his unmatched set of teeth! How could I get his attention?

Doctor Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.” The light bulb came on, and I said, “Tell me about how you made decisions as a CFO in your business.”

“Well, I take a good look at the short and long term impact of the decisions, the cost of capital necessary – both short and long term, and the risk/reward potential to the bottom line of the company.”

Now I was in full swing, “Sounds like you study the problem and/or opportunity with reflection and quite a bit of detail. You slow down and take the necessary time to uncover the best decision.”

“Well, yes, of course, they would be important decisions, and they would take time!” Bob replied.

“Quite honestly, Bob, that is exactly what I and others are attempting to teach dentists at The Pankey Institute. We are asking dentists to intentionally slow down and become more reflective, affective, and effective with their patients.” I could see he was thinking about this.

“Bob, let’s compare you and your teeth to your sets of golf clubs.” He was intently listening. “It’s as if, when you were a young man, God gave you a set of new golf clubs. We, as dentists, call them teeth. You used them through the years as you refined your golf game and in time you broke the 9-iron. You went to the pro shop and tried to get a new one. It was a 9-iron, of course, but the grip, the shaft and the swing weight were not quite the same as your original set. It was okay, because you knew how to adjust if you remembered to accommodate for the differences.

“As time went on, you had the same experience with your 7-iron, the 4-iron, the pitching wedge, and your favorite wood. In time, you were adjusting your swing and muscles every time you swung a club. You noticed there were times when certain muscles would get sore and even the soreness would get in the way of your swing chewing. Finally, you decided to get refitted with a whole new set of clubs. You went to a professional who put you through a whole series of tests and thorough evaluations to diagnose and plan the best solution, which fit your uniqueness. And, you not only got one completely new set of golf clubs, you got three.

“Many dentists would see you as a very busy man who wants to get out of the dental office with dispatch. They respond in a crisis mode to your crisis events. But, like clubs, teeth need to be customized and “matched” to work together so you aren’t constantly accommodating as teeth break and are restored. What we are encouraging dentists to do is to slow down and be as thorough as you would be in your decision making in your business. It’s better for you—actually better for all concerned.”

Bob’s face lit up, “So that’s what you teach?” “That’s what I teach,” I responded

With that “aha” smile, Bob said, “Would you be so kind as to give me your business card with the name of a dentist who thinks like you do? In fact, I’d like three – one for each of the locations of my golf clubs!”

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Richard Green DDS MBA

Rich Green, D.D.S., M.B.A. is the founder and Director Emeritus of The Pankey Institute Business Systems Development program. He retired from The Pankey Institute in 2004. He has created Evergreen Consulting Group, Inc. www.evergreenconsultinggroup.com, to continue his work encouraging and assisting dentists in making the personal choices that will shape their practices according to their personal vision of success to achieve their preferred future in dentistry. Rich Green received his dental degree from Northwestern University in 1966. He was a early colleague and student of Bob Barkley in Illinois. He had frequent contact with Bob Barkley because of his interest in the behavioral aspects of dentistry. Rich Green has been associated with The Pankey Institute since its inception, first as a student, then as a Visiting Faculty member beginning in 1974, and finally joining the Institute full time in 1994. While maintaining his practice in Hinsdale, IL, Rich Green became involved in the management aspects of dentistry and, in 1981, joined Selection Research Corporation (an affiliate of The Gallup Organization) as an associate. This relationship and his interest in management led to his graduation in 1992 with a Masters in Business Administration from the Keller Graduate School in Chicago.

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The Wonder of Relevant Examples – Part 1

March 18, 2022 Richard Green DDS MBA

Doctor L.D. Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.”

Years ago, I had been asked by a young dentist to come to his office and help him with the implementation of his new learning with occlusion applied to bite splints and equilibration. I suggested he line up a few patients for us to work on together during my visit. When we arrived at his office early in the morning to talk about the patients we were going to see together over the next two days, I asked him to bring me up to speed on where he was in treatment with the patients and the conversations he had had with them. We also looked at full mouth models, models of bite splints, and radiographs. I asked him what he wanted me to do with the first patient who was coming in that morning.

He said, “I want to watch you sell him a bite splint!” A little surprised, I asked him to tell me about the patient. He said he was a new acquaintance. They played golf together and occasionally gambled as they played to keep their interest up in the game. They also gave each other a hard time about handicap ratings. He mentioned he felt a bit embarrassed because he thought he knew what was best for his new friend and had kind of hustled his friend on the golf course to be a patient. Now he was feeling a bit guilty about having his new friend come in as a patient, and he could not bring himself to a have conversation concerning the benefits of a bite splint.

Charlie (the friend) appeared, and the dentist introduced me. Charlie and I stood about the same height. We looked each other in the eye, and we smiled at each other – a good beginning. In my mind, I was repeating slowly to myself, “Find a relevant connection.”

I said, “Thanks for taking the time to come in and meet me on such a beautiful Spring day, as I pointed to a comfortable chair for him to sit in.”

He offered something about how golf could be a bit boring if you played it too much. Still looking for a relevant connection, since my “stated task” was to sell him a bite splint, I asked him about his work, and he said he was retired from directing filmed commercials. I asked him what he did with his new found time aside from golf. He smiled a big smile and said he ran about five to seven miles a day. I smiled as I remembered the years when I ran three to five miles a day during the week and seven to ten miles on weekends. A light bulb went on, in my head, and I knew a question I could ask to engage him and tweak his curiosity.

I asked, “How often do you buy new running shoes?” And without hesitation, he said, “Every four hundred miles.” I then asked, “How did you discover that interval?”

He reached down with his right hand and rubbed the lateral surface of his right leg from the mid-thigh, across the lateral surface of his knee, to the lateral surface of his calf, while telling me of the discomfort he would experience in his muscles when the bottoms of his running shoes became worn.

I made the statement, “You must run with the traffic!” Surprised, he asked, “How do you know that?”

I told him I experienced the same thing when I ran on a road with the traffic, especially when the road had a bit of a “crown” on its surface. I thought I had found a relevant connection, and I let it sink in a bit. Then, I told him his dentist friend wanted to offer him a new pair of shoes for the top of his teeth in the form of a removable bite splint. It would be like getting a new pair of running shoes. It would be professionally custom fitted to the tops of his teeth, which would please your chewing muscles and create greater comfort, just like a new pair of running shoes pleased his leg muscles and knee joint.

Charlie looked at his dentist friend and then at me before standing up. With a big smile he said, “I will make an appointment with the receptionist.” Hmmm… Isn’t that Interesting!

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Richard Green DDS MBA

Rich Green, D.D.S., M.B.A. is the founder and Director Emeritus of The Pankey Institute Business Systems Development program. He retired from The Pankey Institute in 2004. He has created Evergreen Consulting Group, Inc. www.evergreenconsultinggroup.com, to continue his work encouraging and assisting dentists in making the personal choices that will shape their practices according to their personal vision of success to achieve their preferred future in dentistry. Rich Green received his dental degree from Northwestern University in 1966. He was a early colleague and student of Bob Barkley in Illinois. He had frequent contact with Bob Barkley because of his interest in the behavioral aspects of dentistry. Rich Green has been associated with The Pankey Institute since its inception, first as a student, then as a Visiting Faculty member beginning in 1974, and finally joining the Institute full time in 1994. While maintaining his practice in Hinsdale, IL, Rich Green became involved in the management aspects of dentistry and, in 1981, joined Selection Research Corporation (an affiliate of The Gallup Organization) as an associate. This relationship and his interest in management led to his graduation in 1992 with a Masters in Business Administration from the Keller Graduate School in Chicago.

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The Examination Is Sacred Time

March 14, 2022 Barry F. Polansky, DMD

Here I share abridged excerpts from my newest book The Porch: A Dental Fable to illustrate why the new patient exam is sacred time that sets the stage for trust.

In this story, Tom Parker, DDS has been invited to shadow a second-generation dentist by the name of Paul Wilson, who has been in practice many years in a small town in upstate New York. Paul is a close friend of Tom’s mentor Henry, and both Paul and Henry have been immersed in opening the eyes of dentists to the possibility of practicing in an intentionally virtuous way that is enriching for both patients and dentists.

Upon arrival at Paul’s dental office, Tom notes that Paul displays photos of his family and dogs, pictures related to his love of skiing and golf, and pictures that indicate he is as a person of prominence in his community. Tom feels like he is back in time to another era.

Paul tells Tom the first patient is a new one so Tom will see what a blank slate looks like for the doctor and patient. When Paul is finished, he escorts Tom into his private office and asks him what he thinks so far.

“To be honest, Paul, you did it just the way Henry taught me.”

“Okay, but what didn’t you see. You know, what was invisible to you?”

“What do you mean?”

“I mean the intangibles. The things we can’t see or touch or even explain sometimes — like love. Let me explain what the positive psychologist Barbara Fredrickson calls the cocoon of self-absorption. Most of us spend our days focused on ourselves. It’s just our default…Frederickson says love appears ‘anytime two or more people, even strangers connect over a shared positive emotion, be it mild or strong.’ The doctor-patient relationship is a dyad in which love can be present…The virtues of love, empathy, kindness, compassion, and gratitude take time.”

“I think Henry mentioned that trust is spelled T.I.M.E.”

“Yes, we like to teach that. And that is why we ritualize the comprehensive examination, so we can leave the cocoon of self-absorption and become other-focused. That is why we ritualize slow dentistry.”

“Slow dentistry…I like that. I also noticed that the first thing you did was thank Gloria for coming in.”

“Congratulations, Tom, good observation. Gratitude is another virtue that is most important for our well-being. Being grateful rather than feeling entitled or taking others for granted is important. My dad taught me that years ago. Every morning he would greet his team and tell them how thankful he was for them being with him. Science tells us that gratitude is a great way to improve our health, happiness, and general well-being. So, I ritualize my greeting, but I really do mean it. I must earn the right to treat them. Did you notice how much attention I was paying to Gloria? It’s a tricky thing. It’s more than just listening.”

“Yes, I have seen active listening demonstrated before, but what you were doing was different.”

“I’m sure Henry has told you there is no instant pudding. We all need to work on our attention. Love is attention. It’s the highest form of love there is. When we learn to pay attention with no expectation of reward, with no agenda, this is the rarest form of generosity. People can spot bogus attention in a heartbeat. Your wife and kids know when you’re not paying attention. Patients know, too. That is why we make the examination sacred time without interruption.

“People want to feel that they are the only one in the room. I always begin with a very open-ended question, for example, ‘What you are going through with your health?’ or ‘What is it that made dental care a priority now?’ I don’t keep a list of questions. I use different ones. Some land well. Others fall flat, but I keep trying, always looking for levels of comfort. The point is to not just acknowledge their presence but to truly notice their presence. This takes another level of awareness. We need to learn their stories. We need to learn their goals, not only their dental goals but their overall health and wellness goals. They want to know that we are here for them in every way.”

Tom’s face lights up in an Aha moment as he realizes love is operationalized through attention that is selfless. The examination is sacred time in which we pay attention – with no expectation of reward.

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Barry F. Polansky, DMD

Dr. Polansky has delivered comprehensive cosmetic dentistry, restorative dentistry, and implant dentistry for more than 35 years. He was born in the Bronx, New York in January 1948. The doctor graduated from Queens College in 1969 and received his DMD degree in 1973 from the University of Pennsylvania School of Dental Medicine. Following graduation, Dr. Polansky spent two years in the US Army Dental Corps, stationed at Fort. Dix, New Jersey. In 1975, Dr. Polansky entered private practice in Medford Lakes. Three years later, he built his second practice in the town in which he now lives, Cherry Hill. Dr. Polansky wrote his first article for Dental Economics in 1995 – it was the cover article. Since that time Dr. Polansky has earned a reputation as one of dentistry's best authors and dental philosophers. He has written for many industry publications, including Dental Economics, Dentistry Today, Dental Practice and Finance, and Independent Dentistry (a UK publication).

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