“Provisional” Versus “Temporary” 

April 12, 2024 Kelley Brummett DMD

Kelley Brummett, DMD 

After you do a crown preparation, do you tell your patients that you’re going to make them a temporary or a provisional?  

Provisionals are more than temporary restorations. They are part of a process. They’re the dress rehearsal to the final outcome. They are the prototypes for the final restorations.  

The “provisional” process is an opportunity to gain trust with the patient while modifying the length of teeth, the shape, or the color. It is also a way to communicate with the patient how their functional and parafunctional findings may have contributed to the destruction of their teeth. 

As the patient comes back to have their bite checked and to talk about what they like and don’t like, we are building trust. We’re involving them in understanding what they feel and think. We’re listening to improve their conditions. 

I’ve had patients who were fearful about moving forward with extensive treatment because they couldn’t envision the transition from the prep appointment to the final. What would those temporaries look like? What would they feel like? How would they function?  

So, when I am discussing a case with a patient, provisionals are all part of one treatment fee. We talk about the prep process, the provisional process, the lab process, and the final seating process—all as one process for which there is a fee. We discuss how the provisionals will guide us in optimizing the lab plan to achieve the desired comfort, function, and aesthetics.  

Whether it’s a single tooth or whether it’s multiple, I encourage you to help the patient understand that what you are providing in the interim between a preparation and a seat of a restoration is called a “provisional.” 

A provisional protects the underlying tooth structure. It keeps tissue in place. It helps the patient feel confident. It allows us to understand what might be going on functionally. It helps us communicate better with the lab. It’s more than a temporary restoration. It’s a guide on our journey toward predictable and appreciated relationship-based dentistry. 

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

User Image
Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Are Your Temporaries a Practice Builder or Simply Temporary? 

April 10, 2024 Gary DeWood, DDS

Gary M. DeWood, DDS, MS 

Many dentists believe that provisional restorations don’t really matter. After all, they are not really a stand-in for the final restoration. I would respectfully disagree. I am a proponent of creating functional, durable, and highly esthetic provisional restorations, every time. They have the potential to impact your dental practice a lot more than you might think. Whether you print them, form them, or free-hand them, a GREAT temporary is a great billboard for your practice. 

  1. Make the provisional as Esthetic as the final restoration.

I contend that the more your provisionals look like what you are hoping for when you seat the final restorations, the more people will talk about them, AND you. 

I was able to build a referral restorative practice by creating provisionals that made patients want to come to my practice and specialists want to send people. For much of our career, almost the entire team of the oral surgery office we worked with, and many of the team members from the other specialty practices we worked with, were our patients in Pemberville, Ohio. 

Front teeth or back teeth, when you make them look like teeth, people will like it and they will show and tell other people. “This is just the temporary?!” was not an uncommon question or exclamation from our patients.  

  1. A GREAT guide makes a GREAT provisional restoration.

Your wax-up** cast/model serves as your vision, as your preparation guide fabrication device, and as your provisional former. When the preparation is appropriately reduced for the material selected, the temporary can mimic the restoration. 

** The wax-up might be created with wax then duplicated with impression material and stone to create a cast, or it might be scanned to be duplicated with resin and printed or milled to create a model. 

  1. 3. Use that provisional to highlight the talents of your team members.

You might LOVE to make those provisionals, but if your assistant is equally excited when it comes to recreating nature for the patient to appreciate, then it could be an opportunity for patients to see that your assistant does much more than set-up, clean up, and hand you an instrument. My dental partner, Cheryl, (who is also my wife) and I actively sought out things that could help our patients experience our team as much more than our helpers. 

As we all know, dental assistants are an integral and vital part of what the practice is and are a powerful force in how and why patients ask for dentistry. Assistants who fabricate provisionals have an opportunity to be seen differently, and we were always looking for ways to create partnership with them in our treatment. 

  1. 4. Take pictures of them.

Photographs of the temporary will make it easier for the lab to design the outcome. They will be able to see what you are thinking, able to visualize what you want, AND maybe even more importantly, see what you do not want. With anterior provisionals, I have frequently noted to my ceramist, “Please put the incisal edge in exactly this position vertically and horizontally in the face, then use your artistry to create the tooth that belongs in the face you see in the photographs of the patient before, prepared, and temporized.” 

There were many times when the technician was able to see and create effects that I might have not recognized as being “just the thing that would make these teeth extraordinary.” And don’t forget to show the patient the photograph. 

  1. 5. Love the material you make the temporary with.

The better the provisional material is at holding tooth position and functional contact, the less adjustment we’re going to have, so using a high-quality material is important. There are a lot of them out there. I like bis-acryl materials that polymerize with a hard surface, have little or no oxygen inhibited layer, and can be polished easily. The polish is more about feeling smooth than about the shine. Ask you patients how their provisional tooth “feels” when you are done, so they sing your praises. 

  1. 6. Use high-quality core material.

When you use a good core material the prep will be smoother, making it easier to fabricate nice provisionals. Ideal prep form goes a long way toward better provisionals. 

  1. ASK your patient to tell people.

As noted above, when you can elicit an emotional response about the awesomeness of your provisional, ask the patient to tell other people, “….and this is just the TEMPORARY!” 

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

User Image
Gary DeWood, DDS

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

The Pre-Clinical Interview – Part 2 

March 11, 2024 Laura Harkin

Laura Harkin, DMD, MAGD 

Let’s delve deeper into the preclinical interview! 

It’s helpful to understand a patient’s perception of their overall health and oral health, as well as what type of restorative dentistry they’re hoping to have and why they feel the way they currently do.  

Sometimes, an integral family member has influenced the timing of care. For instance, you may hear, “My grandchildren are making fun of my teeth” or “My wife asked me to get my teeth fixed.” From this response, I know that I will need to be sure my patient personally desires treatment before rendering it. I’m also anxious to understand what type of restorative dentistry a patient is considering. For example, are they open to removable prosthetics, fixed crown and bridgework, or implantology? 

Recently a new patient came to my office with an emergency. Tooth #5 presented with the buccal wall broken to the gumline and a moderate-sized, retained, amalgam filling. He immediately said, “I do not want bridgework.” I listened quietly until he elaborated by saying, “When I had this front tooth replaced by my other dentist, I had to take it in and out, and I just found that so irritating.”  

I finally understood that he was referring to a flipper but calling it bridgework. So, it’s important to listen and ask questions when someone seems close-minded about having a certain modality of treatment. Delve deeper into the conversation because it may simply be confusion surrounding dental terminology. 

For the grandparents who ask for a better smile, I’d like to understand their thoughts on the scope of treatment and their expectations. Are they looking for a white, straight, Hollywood smile or a more natural appearance with a little bit of play in the lateral incisors? Are they mainly concerned about stains, gaps, or a missing tooth? Are there other problems they’re aware of such as tooth sensitivity, inflamed gums, or the need for a crown? This input is very important as we continue conversation with co-discovery throughout the clinical exam, diagnostic records, and treatment planning phase. 

Learn to count on your chairside for pertinent information. 

I’m fortunate to always have my assistant, Cindy, beside me for preclinical conversations, comprehensive examinations, and restorative procedures. Sometimes, Cindy interprets a patient’s statement or component of conversation differently than me. She may hear a message that I missed or read body language of which I wasn’t aware. Sometimes, auxiliary conversations between patient and assistant take place after I’ve left the room to complete a hygiene check.  

At the end of the day or in the morning huddle, we always take time to discuss interactions with our patients. Together as a team, we’re more efficient at acquiring accurate information so that we may approach the road to health most effectively for each individual. 

Determine if trust is present. 

As I’m getting to know a patient and before I choose to begin restorative treatment, I seek to understand if trust is present in our doctor/patient relationship. New patients often share past dental experiences, and, unfortunately, some have lost trust in dentistry itself. This may be warranted due to improper care, but it may also be due to a lack of understanding or unclarified expectations regarding a given procedure or material choice.  

It’s not unusual, particularly when a patient is considering a large scope of treatment, to serve as a second or third opinion. Building trust and waiting to be asked for our skills are key necessities before moving forward in irreversible therapy.  

The comprehensive examination, periodontal therapy, splint therapy, and gathering of records are all appointments during which opportunities exist to get to know our patients. True trust often takes time to establish, but the reward reaped is frequently one of empathy, friendship, and the ability to do our best work. 

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

Default Avatar
Laura Harkin

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

The Pre-Clinical Interview – Part 1 

March 4, 2024 Laura Harkin

The Pre-Clinical Interview – Part 1 

Laura Harkin, DMD, MAGD 

I am a third-generation, restorative dentist in New Holland, Pennsylvania, which may be best known for its blue, New Holland tractors. I own my grandfather’s and father’s dental practice where I am the sole provider for approximately 1,000 patients. My dental team consists of two hygienists, two assistants, and two front office administrators. 

I graduated from dental school in 2008 after short careers both in the actuarial sciences and as a stay-at-home mom. In 2010, I purchased my practice and signed up for my first course at The Pankey Institute. Note, my father also studied at the Institute when it first opened its doors in the early 70’s. One of my greatest challenges, early in my career, was learning how to diagnose oral conditions, develop and present treatment plans, and execute that treatment via phases. I found it quite overwhelming to simultaneously manage multiple, complex cases. Now, I love sharing my experience and the approach I’ve found works best for me. 

Above all, I’ve learned that in the midst of daily pressures in dentistry, we need to maintain our own health and strength to properly treat our patients and lead our teams. Surrounding ourselves with knowledgeable, positive, and compassionate colleagues helps! 

Knowing ourselves is as important as knowing our patient. 

Dr. L. D. Pankey’s Cross of Dentistry supports the belief that knowing oneself is of equal importance to knowing a patient whom we choose to treat. This challenge forever evolves because no person remains unchanged with time. I frequently evaluate my strengths and weaknesses as a provider, team leader, and mentor. At the same time, I ask myself what aspects of patient care and business management I excel at and most love to do. I can then choose my specialist team accordingly and empower my office team to best support me. 

Together we ultimately provide a better product and higher level of care. 

To prepare specifically for the treatment planning process, my team helps me gather key information and clinical records from a patient for a comprehensive evaluation. After a thorough analysis, I carefully craft written documentation which will help educate my patient, my team, and the specialist team I’ve chosen. An added benefit is its ability to serve as legal documentation.  

I always ask a team member to join me during treatment plan presentations. They bring another set of ears and eyes so that we may better understand a patient’s motivating factors as well as the challenges they may face in receiving treatment. We encourage open and honest conversations and understand that treatment plans evolve to fit the needs of individuals. 

How do we get to know our patients? 

In addition to gathering a thorough health history and dental history, we are seeking to learn more about our patient’s chief complaint, perception of their current state of oral health, desires for treatment, and barriers to care. 

We listen intently for clues to identify a patient’s communication style. I’ve always heard that we have two ears and one mouth for a reason. I practiced with my father for two years and once, after observing me, he said, “Laura, you do far too much talking. You need to really listen to what your patients are sharing.”  

I’ve had to develop the skill of active listening. To stay in the question and become comfortable with silence takes practice. Some observations that I try to make in order to effectively communicate and build a relationship with a patient are as follows: 

  • Do they seem to enjoy conversing or are they responding with short answers in order to get through the interview quickly? 
  • Do they readily ask questions and express thoughts, or are they quiet and need to be invited and prompted to share? 
  • Are they amiable? 
  • Are they distrustful or fearful due to past dental experiences? 

We need to intentionally verbalize our empathy when we’re in conversation with a patient to help them recognize that they’re being both heard and understood. 

It is beneficial to understand a patient’s background. For example, what have they done in life? What do they love to do? Who is important in their life? Sharing in these conversations will help build a rapport, lead to improved doctor/patient communication, and can help to begin a trusting relationship. 

Does the patient have limitations such as the ability to drive to appointments, afford dentistry, or find time for treatment? Do they need to discuss their oral health condition and treatment options with a trusted family member before making a decision? 

Understanding these answers helps us to not only provide respectful and resourceful solutions but also limit inaccurate assumptions. This knowledge is especially helpful in my third-generation practice, where I have many elderly patients who are dealing with health issues, multiple medical appointments, and scheduled drivers. Their desire is to simply make a careful decision for an oral rehabilitation which fits their objectives and abilities. 

Do we hear the desire for treatment? When speaking with an existing patient, I can often recognize signs of interest to move forward with previously recommended treatment. At that point in time, I often ask, “Why now?” The answer helps me clarify their chief concern(s) so that we can move forward fittingly. 

In Part 2 of this series, we will explore additional techniques to clarify our patient’s desire for oral health and long-term, oral stability. 

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

Default Avatar
Laura Harkin

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Getting Case Acceptance to 90%

February 26, 2024 Paul Henny DDS

Getting Case Acceptance to 90% 

Paul A. Henny, DDS 

Studies show that the average comprehensive care treatment plan acceptance rate is in the 30% range. Why do you suppose that is? 

Humankind’s Innate Prediction Machine 

Our brain is a prediction machine that’s always turned on. To a large degree, it operates like the autocomplete function on our phone – it’s constantly trying to guess the next word when we listen to a book, read, or conduct a conversation. Contrary to speech recognition AI bots, our brains are constantly making predictions at different levels, from meaning and grammar to specific speech sounds. Our brain continuously compares sensory information with memories. The more negative the memories, the more negative the predictions. 

Additionally, there’s a central purpose behind our prediction machine: Survival, successful reproduction (propagation of our genome), and rewards that might take the form of rising up in the social hierarchy or gaining scarce resources. 

Regarding survival, our brain likes to stack the odds 4:1 in its favor, meaning, it tends to predict negative outcomes 4X more often than it will positive outcomes. This is nature’s way of staying safe so we’ll have the opportunity to live another day. 

Stacking odds in Its favor is very primal, yet the stacking influences many of our impressions and decisions. Complex situations requiring complex decisions must go through this 4:1 negative bias loop. 

A Steep Slope to Climb 

Now, apply this information to how you work with your patients. Unless you enter a relationship with a stellar reputation that has transferred a high level of trust, you are starting off with 4:1 odds against the advancement of your agenda. That’s a steep slope, yet we ignore that truth every day. 

The only way to overcome the 4:1 odds against us is to allow trust to organically develop in the relationship. And that must be achieved in small steps: Simple proposals, agreements, and experiences that meet unspoken expectations.  

Would you agree to hire a contractor to build your dream home after talking with them for only 15 minutes? Wouldn’t you want to see examples of their work and call one or more of their clients to learn how good they are at following through and sticking to their word? 

I thought so but for some reason, we all want to believe that when a person needs extensive oral restoration or rehabilitation, that they will be ready to make a multi-thousand dollar decision within minutes of seeing our amazing digital presentation. In fact, we’re so confident that it will work, that we’ll do our exams for free to create a “sales funnel.” 

The Common Approach Fails 

Most people don’t react well to this approach because it’s too much information-too fast, and it’s all coming from a virtual stranger. They’re not ready to have us build their dream home for obvious reasons. Why, then, do we ignore all of that and call them “tire kickers?” 

The Alternative Approach 

Dentists who deploy the co-discovery, co-diagnosis, and co-success treatment planning process outlined by Dr. Robert F. Barkley often get above 90% case acceptance. I bet you wouldn’t be surprised to know that Pankey Institute faculty are among them. Understanding how the mind works and structuring your new patient processes to beat the 4:1 odd is more than possible. I invite you to read my recently published book: Co-Discovery: Exploring the Legacy of Robert F. Barkley, DDS. The book is available at the Pankey Institute now with all proceeds benefiting the Institute. 

  

Related Course

Mastering Treatment Planning

DATE: October 2 2025 @ 8:00 am - October 4 2025 @ 1:30 pm

Location: The Pankey Institute

CE HOURS:

Tuition: $ 4795

Single Occupancy with Ensuite Private Bath (per night): $ 345

 MASTERING TREATMENT PLANNING Course Description In our discussions with participants in both the Essentials and Mastery level courses, we continue to hear the desire to help establish better systems for…

Learn More>

About Author

User Image
Paul Henny DDS

Dr. Paul Henny maintains an esthetically-focused restorative practice in Roanoke, Virginia. Additionally, he has been a national speaker in dentistry, a visiting faculty member of the Pankey Institute, and visiting lecturer at the Jefferson College or Health Sciences. Dr. Henny has been a member of the Roanoke Valley Dental Society, The Academy of General Dentistry, The American College of Oral Implantology, The American Academy of Cosmetic Dentistry, and is a Fellow of the International Congress of Oral Implantology. He is Past President and co-founder of the Robert F. Barkley Dental Study Club.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Why I Place High Value on Interdisciplinary Treatment Planning

July 8, 2022 Abdi Sameni

Complex dental cases often need support from multiple specialties for a final successful outcome. The approach to work out these cases can be a “multidisciplinary approach” or an “interdisciplinary approach.”

In the case of “multidisciplinary treatment planning,” each of the dental professionals makes their own plan for the treatment they will provide and they seek the help of other disciplines as the need arises. A fairly common example is when a patient finishes orthodontic alignment and then sees a dentist for esthetic restorations.

“Interdisciplinary treatment planning” takes another approach. Treatment is preplanned among the restorative dentist, specialists, and the laboratory team prior to commencement. What is notable in this approach is that you communicate, you collaborate, and you create the plan together as a team. As a restorative dentist, my role is to sit at the center of the specialist, the lab technician, and the patient. In my experience, involving the lab technician from the beginning produces best results and a more efficient process of treatment.

Avishai Sadan — my colleague and the dean at USC, says interdisciplinary treatment planning results in “being able to formulate a custom-tailored treatment plan that addresses patient present and future needs and to execute it to the highest clinical level possible, using state-of-the-art techniques and technologies.” This statement defines for me the best way to do dentistry.

The Benefits of Interdisciplinary Treatment Planning

The foremost benefit is to our restorative patient, whose well-planned dentistry optimally solves current and future needs. Not only are restorative results at the highest clinical level, but we can practice what we enjoy doing most at our highest skill level, while enjoying collaboration with others who are working at their highest skill level. Liability is lower, and we learn from each other.

As a team, we have developed a smooth process of communicating, contributing knowledge, and deciding what will be an optimal course of treatment. We document with photos the procedures each of us performs so we each have complete documentation of the cases we do together.

The others who are on my interdisciplinary team refer patients to me because they are comfortable with the process we have developed and value the quality of the restorative dentistry I do. My practice is distinguishable from dental practices that do not do interdisciplinary treatment planning. Patients who are referred are commonly told about this interdisciplinary planning approach before they arrive. They anticipate a high level of personal attention and a course of treatment that all doctors agree upon. Case acceptance is high when all doctors and the lab team agree on what is best for the patient. Communication and agreement among the providers is so complete, the patient can be optimally informed about what to expect at each stage of treatment.

Related Course

E1: Aesthetic & Functional Treatment Planning

DATE: July 17 2025 @ 8:00 am - July 20 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 39

Dentist Tuition: $ 6800

Single Occupancy with Ensuite Private Bath (Per Night): $ 345

Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

Learn More>

About Author

User Image
Abdi Sameni

Dr. Abdi Sameni, Clinical Associate Professor of Dentistry at Herman Ostrow School of Dentistry of USC, is the founder and developer of the “International Restorative Dentistry Symposium, Los Angeles.” He is a former faculty for the “esthetic selective” and the former director of the USC Advanced Esthetic Dentistry Continuum for the portion relating to indirect porcelain veneers. Dr. Sameni lectures nationally and internationally. He is a member of The American College of Dentists, OKU National Dental Honor Society and the Pierre Fauchard Academy. Dr. Sameni maintains a practice limited to restorative dentistry in West Los Angeles, California and the 2020 Pankey Institute webinar he presented on interdisciplinary treatment planning can be viewed here on YouTube.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Dental Risk Factors: Management Versus Treatment

June 1, 2022 Lee Ann Brady DMD

One of the most important things I aim to do is create clear expectations for my dental patients. Over the years I have intentionally tried to shift my language from discussing “treatment” to “management” when talking with patients who have dental risk factors that will persist throughout life. Perhaps, the following short discussion will empower you to do the same.

By being intentional about this, we can:

  • Reduce patient frustration,
  • Avoid patients thinking we have failed them,
  • Boost their confidence that we are working together to address their oral health problems, and
  • Inspire them to try management therapies and return to therapies that helped in the past when there are flare-ups.

When I describe something as a treatment versus describe something as a management therapy, I inform my patients about the difference and explain why management therapy may or will never eliminate the underlying cause of their oral health issue — but by continuing to manage their issue therapeutically throughout life, they will hopefully reduce discomfort and disease.

I make a clear distinction that treatment fixes a problem, and in their case, the problem may not be fixable, although it can be managed. For example, I focus on this when the patient is truly at high risk for periodontitis. This is a patient who has suffered from bone loss and has a body that is highly reactive to the bacteria in the inflammatory disease known as periodontitis. I also focus on this when the patient has significant TMD issues.

When I tell a patient, that we are going to treat something, the use of the word “treat” sets the expectation that the problem will be eliminated. That is very different from a management strategy that helps to reduce the symptoms and/or the continued degradation of their oral health. When we tell patients we are going to do scaling and root planning and we’re going to “treat” their periodontitis, it can be really challenging for them when we recommend that they do additional periodontal therapies.

When we think about periodontal risk, functional risk, and caries risk, the reality is that risk is a bell curve. There are some people whose risk factors are easy to manage, and some people whose risk factors are very challenging to manage. We need to help patients understand that when they have certain risks, certain disorders, there really is no treatment. What we do have is a lot of therapeutic modalities that can help manage the damage, manage the symptoms. Sometimes these modalities are so effective that it appears the disorder has gone away.

We need to recognize and the patient needs to know that the disorder really has not gone away and can surface again. With clear expectations, our patients (and we) do not have to experience disappointment and frustration. Instead, we can have supportive, empathetic conversations, and move ahead with restarting therapies and trying new ones.

Related Course

E1: Aesthetic & Functional Treatment Planning

DATE: August 21 2025 @ 8:00 am - August 24 2025 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 39

Dentist Tuition: $ 6800

Single Occupancy with Ensuite Private Bath (Per Night): $ 345

Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

Learn More>

About Author

User Image
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.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Easy to Mount Printed Dental Models

February 14, 2022 Mark Kleive DDS

In my dental practice, we often use mounted models for diagnostics and restorative treatment planning. Three years ago, we began 3D printing these models.

One of the benefits of printed models is their higher durability compared to stone models. Also, long term, we do not need to save the printed models because we have the digital models saved in the patient’s file. But the greatest benefit has been the efficiency gained in mounting models on articulators. As a result, we have decreased our overhead and increased our mix of services.

What made this mounting efficiency possible is software called “Blue Sky Plan” from Blue Sky Bio. Blue Sky Plan is advanced dental treatment planning software used for milling and printing dental products. One of its applications is printing surgical implant guides, but it has many dental and medical applications for anatomical modeling, surface editing, and offsetting. It allows for CT scan importation and analysis, and export to STL format for 3D printing.

When dental models are printed, the interior can be hollow with a waffle pattern on the back that makes articulator mounting super easy. The process is as simple as opening the software, going to editing, importing your scan, and then selecting a hollow model with the waffle base. To print the waffle base on the model, you need to scan the entire pallet.

Related Course

E4: Posterior Reconstruction and Completing the Comprehensive Treatment Sequence

DATE: November 7 2024 @ 8:00 am - November 11 2024 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 44

Dentist Tuition: $ 7300

Single Occupancy with Ensuite Private Bath (per night): $ 290

THIS COURSE IS SOLD OUT The purpose of this course is to help you develop mastery with complex cases involving advanced restorative procedures, precise sequencing and interdisciplinary coordination. Building on…

Learn More>

About Author

User Image
Mark Kleive DDS

Dr. Mark Kleive earned his D.D.S. degree with distinction from the University of Minnesota School of Dentistry in 1997. Mark has had experience as an associate in a multi-clinic setting and as an owner of 2 different fee-for-service practices. For the last 6 years Mark has practiced in a beautiful area of the country – Asheville, North Carolina, where he lives with his wife Nicki and twin daughters Meighan and Emily. Mark has been passionate about advanced education since graduation. Mark is a Visiting Faculty member with The Pankey Institute and a 2015 inductee into the American College of Dentistry. He leads numerous small group study clubs, lectures nationally and offers his own small group programs. During the last 19 years of practice, Dr. Kleive has made a reputation for himself as a caring, comprehensive oral healthcare provider.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

Tricky Questions About Orofacial Pain You Encounter in the Dental Office

July 1, 2021 Dr. Mary Charles Haigler

Orofacial pain is one of the greatest diagnostic challenges that exists in the modern dental practice. It takes a keen ear to listen for the nuances it presents and to know which diagnostic path to follow. The trickiest element of pain is its inherent subjectivity. But as clinicians, we have to learn to determine where the pain actually is, versus just where patients feel it.

Treating orofacial pain is first and foremost about learning the true source of the issue. To do this effectively, you have to be asking the right questions in the right situations. Pain can seem mysterious from the outset, but once you dive deep, you may find a trail of clues leading you to the first set in a litany of possible solutions.

Keep reading to learn some of the questions you should ask when you encounter orofacial pain.

Key Questions To Diagnose and Treat Orofacial Pain

Consider these common and crucial questions regarding orofacial pain:

Toothache

Have you ever had a patient present with a toothache, but you see absolutely nothing wrong with the tooth? It has no visible cracks, any restoration present seems okay, the tooth has no associated radiographic lesion, periodontal probing is normal, and it tests vital.

Should you provide an endodontic treatment or extract the tooth anyway? Is the patient just making it up? Or could this be referred pain from a trigger point, a headache disorder, neuropathic pain, or pain secondary to another condition?

TMD

Or maybe you have a patient who presents with Temporomandibular Joint Disorder (TMD) symptoms, it may or may not be painful. What should you look for and how should you treat it?

Possibly, you have a patient who gets headaches, or earaches, and you wonder if they could be related to TMD. What should you do to try to answer these questions? How do you determine if it’s muscular, joint, or both?

Diagnostics

What diagnostic tests should you order and when should you order them?

Treatment

What are the best way to treat these conditions? What conservative options are there? Is there more that can be done if my patient is unresponsive?

There are no easy answers to these questions and many more that arise for patients in pain. This is an area where you can transform a patient’s life, so it’s important to know what to ask, when, and what answers to look for.

On Friday, July 9th, 2021 from 2-5 pm ET, I’ll be holding a live, three-hour virtual course, “An Introduction to Orofacial Pain,” that will dive into these types of questions. You can easily register for my course, which provides 3 CE credits, at Pankey Online.

I will go through a review of TMJ and masticatory and auxiliary muscle anatomy. I will also discuss how these muscles and the joint should function, plus symptoms if they are not functioning properly. We will also discuss a variety of treatments for different types of TMD.

I will cover referred pain, which is the reason that the site and source of pain do not always match. We will also review other disorders that can be in the differential for tooth pain or for TMD. Sometimes these differentials require additional tests. We will determine what to order and when. We will also go over the best ways to talk about the diagnosis with the patient.

I look forward to sharing an overview of what we focus on in Orofacial Pain and how to gather information to answer the questions above. Please join me on July 9th to dive into these topics!

Related Course

The Pankey Assistant’s Experience

DATE: June 12 2025 @ 12:00 pm - June 14 2025 @ 7:00 pm

Location: The Pankey Institute

CE HOURS: 17

Regular Tuition: $ 2050

Single Occupancy Room with Ensuite Bath (Per Night): $ 345

This “can’t miss” course will empower Dental Assistants to bring their skills to excellence! During this dynamic hands-on course, led by Pankey clinical team member, Sandra Caicedo, participants will learn…

Learn More>

About Author

User Image
Dr. Mary Charles Haigler

After her graduation from Laurens District 55 High School, Mary Charles Haigler, DMD, MS attended Winthrop University, where she graduated with a BS in Biology. Dr. Haigler went on to the Medical University of South Carolina’s College of Dental Medicine, earning her Doctorate. While attending, she was an active member of the American Student Dental Association, Psi Omega Dental Fraternity, and the American Association of Women Dentists. She received honors, including the National Council Scholastic Achievement Award from Psi Omega and membership in Omicron Kappa Upsilon, the national dental honor society. She is a Fellow of the Academy of General Dentistry (FAGD) and a Diplomat of the American Board of Orofacial Pain. Dr. Haigler completed the Essentials Courses at the Pankey Institute and embraces their dental philosophy that focuses on knowing each patient, and providing the best care she can for you. This level of focus also helps to ensure that every patient is treated with individual care and attention.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR

From Your Practice to the Lab – Continuation of a Philosophy of Treatment

May 28, 2021 Josh Polansky

This blog is a precursor for the long lecture I will do on this topic at the 2021 Pankey Symposium.

Over the last decade, there have been major changes in how we do things in our laboratory (Niche Dental Studio), but from small cases to full mouth and hybrid cases, traditional Prosthodontic protocols still guide everything we do. These foundational processes provide a structural/philosophical approach for all our cases.

It’s a philosophical approach to diagnosis and treatment that you have been learning in your Pankey Institute courses. It’s an approach that extends from your dental practice into our lab, so our lab becomes part of your practice.

What are the key principles of this philosophy or approach?

  • We will use optimal diagnostic protocols, communication, technology and methods to deliver custom prostheses as efficiently as possible while not compromising on the quality of the products.
  • We will do our best to deliver products that meet or exceed your expectations for optimal function, comfort, and natural esthetics.

Here are some of the things that we do the same and some we do differently than we did ten years ago.

Feldspathic ceramics still produce the most natural appearance.

In the past everything we made was made by hand, and it was the prosthodontic protocols of this handwork that enabled us to have success using CADCAM technology today. And while today’s CADCAM dentistry is great, it does not replicate the results of restorations made by hand. A machine can’t mill “infinity margins.” Monolithic materials used in milling do not contain multiple levels of opacity.

To blend perfectly with Nature, restorations must still be made by hand, and in our laboratory, feldspathic veneers are still our “go to” type of restoration for central incisors. Layered feldspathic ceramics not only look the best but also are the best for marginal integrity. The restoration on number 8 below is an example.


For fit and finish, these types of anterior restorations are still the prosthodontic foundation of our Niche Dental Studio.

We still aim to replicate natural teeth.

Another foundational attribute of prosthodontic protocols is to replicate nature. Part of our success has been how much time and effort we have put into studying natural teeth and helping Pankey Institute trained dentists distinguish themselves by using restorations that are exquisitely made to appear natural and blend in the patient’s smile.

Today’s patients desire natural esthetics once they understand the elements of what makes teeth appear natural. If a patient seems stuck on a cosmetic dentistry meme of the past and requests whiter, brighter, straight teeth that will not blend in their smile, a conversation with your patient that illustrates tooth, smile, and facial esthetics will be appreciated by your patient and distinguish you as a caring, exacting dentist.

To create restorations that appear natural and don’t “jump out,” we do the following things:

  • Increase the “value” of the color but not enough to create harsh contrast.
  • Play with the levels of the incisal embrasures and the translucency.

These prosthodontic protocols can be implemented by you, too, while doing composite build-ups.

We use new technology to optimize communication.

From the ceramist’s perspective, I don’t want to see just close-up images of teeth. I want to see the patient. For many of our cases, we see the patient in our lab. Local patients come in for a consultation. We consult with other patients via Skype or Facetime. Seeing the entire smile, the entire face in natural interaction, aids us in doing our best.

 Modern 3D technology has changed how labs communicate visually with doctors and their patients. We’re constantly sending 3D screen shots back and forth with our doctors so they can check out the design and show them to a patient. An image like this one is confusing to patients. So, we’ve been able to integrate those screen shots into a photo of the patient to create a virtual image the patient grasps more easily.

CAD technology allows us to work more efficiently, but we still hand-finish restorations.

In our laboratory, we mill a lot of lithium disilicate crowns for clients. Prior to milling the lithium disilicate, we like to mill the restorations in wax. The milling quickly does 80% of the model creation and gives us the opportunity to hand finish the other 20% as we traditionally would. We can now put all our esthetic and creative efforts into finishing the case. We also mill temporary restorations from IOS data without hand modifying them.

Using IOS and CAD has made the lives of our clients much easier. For example, in the past, with full mouth cases, we did a lot of wax-ups when raising verticals. The doctors found working with matrixes too time consuming. They preferred working with eggshells and would reline them. Little problems would creep in when seating these eggshells. Perhaps, the cant was a little off or the vertical wasn’t raised accurately. With 3D imaging, it is far easier, because now we can do our full mouth wax-ups, scan them, and print the eggshells from scans with full palatal rest and retro-molar rest. There is now only one definitive way to seat the eggshells.

This is just a taste. There is so much to share.

To see how we do actual cases, in detail, go to the free Pankey Webinar: Prosthodontic Protocols for the Modern Dental Team. There you will see how our modernized approach, guided by traditional prosthodontic processes, becomes an extension of your treatment goals. I look forward to sharing more with you at the 2021 Pankey Symposium.

Related Course

Pankey Scholar 15A

DATE: January 16 2025 @ 6:00 pm - January 18 2025 @ 3:00 pm

Location: The Pankey Institute

CE HOURS: 0

Dentist Tuition: $ 3495

Single Occupancy with Ensuite Private Bath (per night): $ 345

“A Pankey Scholar is one who has demonstrated a commitment to apply the principles, practices and philosophy they learned through their journey at The Pankey Institute.”   At its core,…

Learn More>

About Author

User Image
Josh Polansky

Joshua Polansky earned his Bachelor of Arts degree, Summa Cum Laude, from Rutgers University in 2004. While working part-time at a dental laboratory, he took advantage of an opportunity to apprentice with distinguished master technician, Olivier Tric of Oral Design Chicago. Mr. Tric opened Joshua’s eyes to a whole new world of possibilities. He made the decision to become a master dental technician following the path that Tric had forged. He continued to acquire technical skills by studying in Europe with other mentors and experts in the field such as Klaus Muterthies. Joshua earned his Masters degree in dental ceramics at the UCLA Center for Esthetic Dentistry under Dr. Edward McLaren. Joshua Continued his training under Jungo Endo and Hiroaki Okabe at UCLA’s advanced prosthodontics and maxillofacial program working on faculty and residents cases. Joshua currently resides in Cherry Hill, NJ where he is the owner and operator of Niche Dental Studio.

FIND A PANKEY DENTIST OR TECHNICIAN

I AM A
I AM INTERESTED IN

VIEW COURSE CALENDAR