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.  

2. 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. 

3. 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. 

4. 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. 

5. 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. 

6. 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. 

7. 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!” 

Charlie Ward, DDS  

Whether you want to use a digital SLR camera for documentation, patient education, lab communication, making presentations at dental events, dental publications, or accreditation in the American Academy of Cosmetic Dentistry, you have choices to consider in multiple price ranges.  

Dentists can spend $1,800 and get a good system for documenting cases, patient education and lab communication. Dentists can easily spend $3,800 or more on a setup to equip themselves to take higher quality images. 

Camera Body: Most dentists shoot with a Nikon or Cannon DSLR camera. These are comparable brands. My experience is with Canon but my lab technician uses Nikon and gets wonderful results. I am shooting with the Canon EOS 90D. The comparable Nikon is the D7500. More entry-level models are the Nikon 3500 and the Canon Rebel T8i. 

Lenses: We can get a third-party Sigma 105mm or a Tokina 105mm lens that gives us decent quality, or we can purchase the Canon 100mm or Nikon 105mm version at twice the price. When I upgraded to the finer Canon lens, I noticed a huge difference in image quality. I recommend an upgraded lens for the highest-quality images you need for accreditation. 

Flashes: The ring flash is a great entry-level option and significantly less expensive but there are limitations to what you can do to control your light. I’ve been using a dual point flash for some time. I can pull a flash off and shoot from a different angle. By changing where the light is coming from, I can accentuate the angle lines for more depth and visual clarity.  

Sometimes, I’ll take one of my flashes off, hold it on the opposite side of what I am shooting, and shoot the flash back into the lens of the camera. When I do this, I get an ethereal-appearing image or an image with a white background. I appreciate the versatility of using the dual point system.  

For my best-looking images and portraits, I’ll use softboxes. This gives smoother, more diffuse light and a beautiful appearance. These are necessary for everyday dentistry but make a huge difference in showcasing aesthetic cases.  

Consider the Long Term: When dentists invest in cameras and lenses, they typically use them for a long time. If you are on the fence about how much you want to invest, my own experience might be helpful. I honestly wish that I had upgraded sooner than I did with the Canon EOS 90D and the Canon 100mm lens. After taking photos for 12 years, the upgraded equipment has only increased the joy I have for photography and pushed me to take more pictures! 

Dental Sleep Medicine in Restorative Practice Part 9: Marketing Dental Sleep Medicine 

By Todd Sander DDS 

How do you start reaching out to physicians and other providers to build a dental sleep medicine practice? Start with the ones you know. Start with your own personal physician and start a conversation. If your dental patient is on CPAP, get permission to converse with their doctor. I spend time contacting many primary care doctors and find they are the ones who know patients are non-compliant with their CPAP therapy. They help me get patients re-evaluated by a sleep specialist. 

This may not be true in your community, but in Charleston, SC, where I practice, many primary care doctors don’t know what to do with their non-compliant CPAP patients. They are thrilled to have someone to refer them to try alternative therapy. 

Years ago, I reached out to sleep testing centers to communicate my services. Both independent sleep labs and hospital-based sleep labs have been great sources of referrals. For many years, I was the dental advisor to a sleep lab. A great conversation starter with sleep physicians, is the potential of combining CPAP and an oral appliance. This often allows the CPAP air pressure to be turned down so their patients be more comfortable and compliant. 

When you screen your dental patients for airway issues such as sleep apnea and snoring, the next step is referring your patients with issues for a sleep study. When the patient discusses their symptoms with their primary care physician or a sleep physician, you are mentioned and often documented as making the referral. Over time, physicians come to know you as a go-to provider of dental sleep appliance therapy. This process is sped up when you take the time and initiative to contact your patient’s primary care physician with your patient’s permission. You can guide physicians and remind them of the recommended standards-of-care, including appliance therapy in place of or in combination with CPAP therapy. 

Some patients self-refer to me, as friends and family talk about their experiences in my office, but I am not spending money on digital advertising to bring in dental sleep medicine patients. Mostly, they are referred to me by physicians, dentists, and other patients.  This is the same for my dental practice. 

As mentioned in a previous part of this series, our hygienists have attended dental sleep medicine courses with me and screen for airway issues. They adeptly educate and guide patients who have signs and symptoms to schedule an examination and consultation with me. 

Note: When patients are referred to me for dental sleep medicine, I never encourage them to become dental patients in our practice. This is a choice they might make but I am extremely careful to refer patients referred by a dentist back to their referring dentist for all dental needs. I am an adjunct to help other dentists’ patients fulfill a prescription for a dental appliance. 

If a patient comes in for sleep-disordered breathing but is also experiencing facial pain or TMD, I understand that this patient’s two issues are likely connected and I will not be able to successfully treat one without treating the other. This is an opportunity to communicate in depth with the referring dentists and let them know I plan to treat the patient for both issues simultaneously. This has been easier for me to do because I have had years of experience in treating facial pain and TMD issues in my dental practice, as well as sleep apnea and snoring.