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Beautiful Smiles…

Todd Snyder, DDS, FAACD, FIADFE

..with Composite Bonding

Accredited, American Academy of Cosmetic Dentistry

Fellow, International Academy for Dental Facial Esthetics

Former Faculty, UCLA Center For Esthetic Dentistry

Faculty, Esthetic Professionals

CBDO, Contentactivator.com

CBDO, Blux.com

Todd Snyder, DDS, AAACDLaguna Niguel, CA

Aesthetic Dental Designs®

doc@tcsdental.com

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▪ All the work shown is my own and unaltered

Catapult Education is the only dental CE provider that integrates clinical

expertise, management effectiveness, and growth strategies to support thriving

practices.

• Many of Dentistry’s Most Trusted Educators

• Practical, Actionable CE That Helps Practices Grow

• Reviews & Leading Edge Topics

• Simple Online Education Format & Live Events

• How To Get More Cases• Photography is Critical for cases & self evaluation• Adhesion• Preparation Designs• Cases, Tips & Materials• Texture & Polishing• Business Tips• Software Products• Getting More Cases..

• a d d fadf jas

Key Points -

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According to the American Academy of Cosmetic Dentistry 50% of patients are unhappy with their smiles and 3 out of 5 people will invest in their smiles.

WHITENING

Immediate Call to Action Motivator

Start Here

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Over-the-Counter Teeth

Whiteners: $1.4 billion

(MSNBC) ...

(Consumer Reports).

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Whitening

Opalescence GO!• Fast, Easy, Effective, Better

Experience• Convenient & affordable

professional whitening to GO• Pre-loaded, disposable UltraFit™

tray for a custom-like fit• Molar-to-molar coverage• No chair time

6%, 10%, 15% Hydrogen Peroxide w/ PF.

Peach, Mint, Melon Flavors

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Opalescence Go Sample Tower

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WHITEN FIRST

Website/Internet/SEO

Social Media

Personal Case Books

Office Displays

Referral Cards

Gift Cards

Custom Smocks & Bleach Kits

Invest in technology.

-Office iPad

-Camera

-Lobby Television

-Software

Modern Tools**

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Dedicated Website Landing Page

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Be VISIBLE!!

• Market to people that want bonding.

• Have your website company build a single page that is specific and optimized for Cosmetic Dental Bonding

• Show before and aftercases

• Provide a brief description of what can be done.

Cosmetic Alterations

• How many of you want to buy something sight unseen?

• How many of you want to experience something first before investing?

• Your patients are no different!

• They are concerned about how it will look and feel. They want to be excited and happy!

• Don’t Just Tell…..Show & Tell!

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Overall Feel

Appearance…what is it? who decides, Dentist? Ceramist? Patient? Combined effort?

THEIR DECISION √

Diagnosis & Treatment Planning

The Key to Success:

VisualizationWhat is the patient’s perception or desired outcome in their mind?

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SHOFU EYESPECIAL CIII

EYESPECIAL C-II (SHOFU)

• Designed for dentistry

• 8 modes

• 12 Megapixels

• Dental cropping and grid lines

• Large LCD touchscreen

• Water and chemical proof

• Durable rugged Exterior***

• Fast autofocusing & anti-shake capabilities

• Held with one hand – weighs only 1lb

• Compatible with the Eye-Fi X2 card – Immediately upload

images onto PC, iPad, Tablet or Smartphone

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MAGNIFICATION RANGE• Chose the magnification ratio/range by rotating the dial key

• Icons to help you determine and select the range properly

STANDARD MODE

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EDIT & DRAW FUNCTION ON THE

EYESPECIAL C-II

• Edit functions are ideal for

patient education

• Under the Menu key you can:

• Draw on images to show

areas of focus

• Rotate the image

• Protect the image against

being deleted

WHITENING MODEFOR SHADE COMPARISON BETWEEN BEFORE AND AFTER WHITENING

• Similar to “Low-glare” mode but with lower light intensity

• Reduces glare and emphasizes the surface texture and shade

• Delegated Whitening & Imaging Assistant

Upper arch whitened

Lower arch not whitened

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ISOLATE SHADE MODEFOR OPTIMAL SHADE MATCHING

Quadrant Dentistry

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Cosmetic Dentistry

Cosmetic Dentistry

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• Additional Products

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SHADE SELECTION

What do they want or envision?

Look at books or imaging together

Bring in examples of smiles

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Everyone has an opinion & priorities

How WHITE?

Translucency?

What Texture?

Color Transitions

Overall Feel Motivation

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When you hand a Cosmetic Imaging to your patient, you plant a seed of what is possible, a constant reminder of what their potential new smile can be. They can show it to their friends and family, you can put a copy in their chart for follow-up, have them hang it on their refrigerator...!

Why Does this Work?

•Creates awareness

•Suggests the possibility

•Promotes discussion

•Provides bridge to clinical evaluation and

presentation of options

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The Key to Success:

Traditional Veneers

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Diagnosis & Treatment Planning

The Key to Success:

Traditional Veneers

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You are selling the Emotion…

Do you know the outcome…

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Elective Orthodontic Procedures

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Handpiece Lubricants

Long term failure occurs at gingival margins and adhesive interfaces.

Yiu CK, Hiraishi N, King NM, Tay FR. Effect of dentinal surface preparation on bond strength of self-etching adhesives. J Adhes Dent. 2008 Jun;10(3):173-82.

Higher bond strengths when using tungsten carbide burs with SE adhesives

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Preparation• Limited to removal of pathology with the exception of access and bevels.

• Maintaining enamel and superficial dentin

• Rounded line angles

• Purge hand piece oils

• Bur Choice

Disposable Single Use Diamonds

Disposable Single Use Operative Diamonds

TEXT “DIAMOND3” TO (770)212-2090

FREE!!

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Total etch Self etch# of

components

Etchant

Primer

Adhesive

The Bonding Agents

Generation4th 5th 6th 7th

Universals

OR

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Total-Etching

Bonding to Enamel/Dentin

Self-Etching

Bonding to Enamel/Dentin

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Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process - Self-Etching

Dentin fluid

Use Carbide Burs Large layers inhibit acidic monomers

Duration of exposure& acidity

Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process - Self-Etching

Dentin fluid

Self-etching adhesiveUse Carbide Burs Large layers inhibit acidic monomers

Duration of exposure& acidity

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Dentin

OdontoblastDentinal tubule

Smear layer

Adhesion process - Self-Etching

Dentin fluid

Self-etching adhesiveUse Carbide Burs Large layers inhibit acidic monomers

Duration of exposure& acidity

Adhesion process - Self-Etching

No Post- Operative Sensitivity

Excellent sealing and desensitizing

FixingOdontoblast

Sealingthe DentinHybrid layer

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Composite

Adhesion process - Self-EtchingBonding

Excellent sealing and desensitizingFixing

Odontoblast

Sealingthe DentinHybrid layer

Factors that compromise bond durability in restorative dentistry

“The major shortcoming of contemporaryadhesive restoratives is their limited durability in vivo.”

alarming

words …

but

the

reality

we

face

should

trigger

alarm

Hydrophilic dentin bonding (1956 - )

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Factors that compromise bond durability in restorative dentistry

Hydrophilic dentin bonding (1956 - )

We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong

direction

Water sorptionPolymer swelling

Decline in mechanical propertiesLeaching of hydrolyzed resin components

Factors that compromise bond durability in restorative dentistry

Hydrophilic dentin bonding (1956 - )

Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially disappeared after 6 months of

intraoral function

Instability of hybrid layers- problem may be more severe than we realize

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Factors that compromise bond durability

Hydrophilic dentin bonding (1956 - )

MMP-8MMP-2MMP-9

Demineralizing dentin is like openingthe Pandora’s box, releasing

endogenous enzymes (Matrix Metalloproteinases - MMPs)

that were trapped withinthe mineralized dentin matrix.

In the presence of water (such as thatderived from water sorption or from

adhesives, MMPs (2,8 & 9) can breakdowncollagen fibrils that are not protected

by intrafibrillar minerals

Sukala et al. (2007)Mazzoni et al. (2007)

Bond Degredation

• Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011 Sep;32(7):60-4, 66.

Resin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months.

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Without

chlorhexidine

With

chlorhexidine

as a MMP

inhibitor

Chlorhexidine prevented degradation of hybrid layers created by

Prime&Bond NT after 12 months of intraoral function

Brackett et al. Chlorhexidine preserves hybrid layers

but not nanofillers in vivo. Oper Dent (2009)

MMP inhibition with chlorhexidine

Potential ways to extend bond longevity

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•Courtesy Pacific University (Dr Marc Guisberger)

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•Courtesy Pacific University (Dr Marc Guisberger)

InstroN• Ultra Tester (Ultradent)

• Ultra Jig (Ultadent)

Ultradent’s shear bond strength testing method has been adopted as an ISO Standard. The UltraTester machine uses this highly accurate method to determine bond strengths.

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Ultradent Internal Testing

Shear Bond Test Results - 2012Average Shear Bond Strength to Dentin: 24.2 MPa

•Courtesy Pacific University (Dr Marc Guisberger)

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Maximum/Minimum Shear Bond Strength per Bonding Material

Shear Bond Test Results - 2012•Courtesy Pacific University (Dr Marc Guisberger)

Why different pH?

3.2 2.7 2.54.6

MDP Penta-P MDP BPDM

Adhesive Functional

Monomers

MDP

2.3 1.6

GPDM

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When bonding to enamel, an etch & rinse approach is definitely preferred, indicating that simple micro-mechanical interaction appearssufficient to achieve a durable bond to enamel. When bonding to dentin, a mild self-etch approach is superior, as it {MDP} involves (like with glass-ionomers) additional ionic bonding with residual HAp. This additional primary chemical bonding definitely contributes to bond durability. Altogether, when bonding to both enamel and dentin, selective etching of enamel followed by the application of the 2-step self-etch adhesive to both enamel and dentin currently appears the best choice to effectively and durably bond to tooth tissue

Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent Mater (2009),doi:10.1016/j.dental.2009.11.148

• Developed by Kuraray 1983

• Acidic Monomer Activates Silanes & Chemically Bonds to Metal Oxide Ceramics (Zirconia & Alumina).

• (Key Ingredient to make a Silane Universal)

• Hydrophilic & Hydrophobic

• Very Durable Dentin Bond

(Creates An Insoluble, calcium Salt with Dentin)

• Is The Most Copied Monomer In Dentistry

• The Most Researched Monomer In Dentistry

• 20 + Years Of Research On Metal Oxide Ceramics (Zirconia & Alumina)

• Strongest & Most Durable Bond to Metal Oxide (Zirconia & Alumina) Ceramics

MDP ADHESION MONOMER:

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NEW “UNIVERSAL” SYSTEMS

• Simple & easy to use

• Direct & indirect techniques

• Use as Total, Selective or Self Etch

• Low sensitivity

• Lots of MDP Based Products

G-PREMIO BOND (GC AMERICA)

• MDP based Universal Bonding Agent

• Total, Self or Select Etching

• Direct & Indirect Composites

• All Ceramics, including Zirconia

• Single bottle or Unidose

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Small Cases have increased Difficulty due to

• Color matching - take photos, and practice composite selection on tooth

• Translucency - take photos, extend composites off incisal edge

• Masking margins - preparation must have a bevel on one or both sides

• Texture• smooth surface is easy but takes longer to polish to eliminate imperfections

• anatomy and texture hides colors better and takes less time.

• Polish - use multiple viscosities and/or polishers

Class IV / Diastema Template Technique

Anterior Composite Bonding

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Vit-l-escence1994

high-translucency, opalescent/translucent

micro-hybrid system

average particle size of 0.7µm.

Vision is critical use photography

Black and White photography to see translucency effects

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Select all composite colors first before dehydration occurs

Place small increment of composite on tooth or extending from tooth and cure for 5-10 seconds.

Place

Evaluate color and add additional colorsEvaluate

Layer a translucent on top of dentin/body colors, or extend off of incisal edgeLayer

Create a Lingual Template whenever possible

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Extend bevel either half or full width of defect

Labial and lingual bevel or chamfer

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Labial and lingual bevel or chamfer

Labial and lingual bevel or chamfer

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Don’t over bevel on incisal edge, it creates more translucency to oral pharynx

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Use mylar when etching and bonding. Use wax floss on adjacent tooth if needed.

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Enamel shade on matrix to build a shelf

Compress composite into position

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Tease composite off adjacent tooth and adapt

Use mylar to create interproximal shape

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Hold against tooth for contour and pull to lingual

Light adaptation to push composite against adjacent tooth creates the contact. Use brush to thin facial finish line or metal instrument.

Try to create all anatomy and shape to minimize contouring steps with handpiece

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Begin to define line angles

Carborundum stone (Shofu) Dura-Green Stonesfor minimal reduction and texture

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Flip discs when contouring interproximal

• Coarse

• Medium

• Fine

• Super Fine

• Polishing Pastes

• Aluminum Oxide Buff

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Jiffy Polishing System

Absolute Polishers (Parkell)

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Polishing Systems

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Radiometers

RadiometerCheck daily in am300mW/cm2 (600mW /cm2)

How good is your light?Initial study by Dr.Nassar Barghi found

▪ 30% of units tested had output less than 200mW/cm2

▪ Second study <20%

▪ Intensity of light inversely proportional to age of unit

▪ 10% had cracked filters

▪ Most doctors never replaced the bulb

**Proper care of curing light will ensure that your restorations are thoroughly cured. **

• More efficient than Halogens

• Halogen produces light from 370 to 800 nm then filters out all

but blue light in 400-500 nm range

• Longer lasting / Cordless / Batteries

• Faster curing (5 seconds)

• Nanometer range closely matched CQ range (450-470)

• Smaller in size/lighter

• Less heat

Benefits of LED Lights

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Comparisons - Lights

Access to the curing site = Energy to the

resin

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$200 $205

$321

$73

$175 $175

$11

$0

$50

$100

$150

$200

$250

$300

$350

Demi Demi Plus Elipar S10 SmartLite Max Bluephase Style Bluephase G2, 16-20i VALO

Curing Light Replacement Battery Cost

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• Unidose and Syringes

• High density uniform dispersion 300nm spherical nanofiller technology

• Self shining effect allows the material to increase polish over time

• Excellent handling

• 17 Shades

• 2 Enamels

• 2 Bleach

G-aenial Sculpt Cosmetics

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Mockup shade and then remove composite interproximally. Restore one tooth to completion then the second tooth.No matrix is necessary as tooth shape is present.

Mockup shade and add length then create a matrix. Restore one tooth to completion then the second tooth.

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• Nanohybrid

• Superior handling

• High polishability & gloss retention

• Exceptional wear

• Unique syringe design

• Intuitive shade offering

One Shade of Mosaic

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Layered shade guide made of composite

13 Dentin Shades

Tapered Handle = Dentin Only

Tooth = Dentin + Enamel Neutral

6 Enamel Shades

Not Layered

Opaque White

Not Layered

2mm

.5mm

.5mm discs

Consistent chromatic progression between shades

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Shade is printed on syringe barrel

and handle tip of syringe

Convenient flip cap stays

connected to the syringe

Unique, hygienic syringe design is

easy to clean. The ergonomic handle

covers syringe threads for reduced

risk of contamination.

Shade category

indicated by color-

coded syringe handles

Enamel = White

Dentin = Beige

Use air abrasion whenever possible as it creates more surface area to adhere too.

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One Shade of Mosaic

One Shade of MosaicUse gauges to measure teeth to create best outcomes.

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One Shade of Mosaic

Measure both teeth and add to just the smaller tooth when ever possible. Pack a small #00 retraction cord to push tissue back.

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One Shade of Mosaic

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One shade this week

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Second Case This WeekThree Shades of Mosaic A3, EN, EY

Photos, Color & Trans, Mockup, Template

Key to Accuracy, Consistency & Speed

Three Shades of Mosaic A3, EN, EY

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Shape, Texture & Polish

Second Key to Accuracy, Consistency & Speed

Three Shades of Mosaic A3, EN, EY

Three Shades of Mosaic look at final texture and polish

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Large Cases are time consuming, but Easier

• Changing the color of many teeth at once is easier as you remove many of the small colors.

• Takes longer to do more teeth however.

• Use retraction cord at gingival to push tissues back so margins can be at or slightly under gum line.

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• Unidose and Syringes

• High density uniform dispersion 300nm spherical nanofiller technology

• Self shining effect allows the material to increase polish over time

• Excellent handling

• 17 Shades

• 2 Enamels

• 2 Bleach

G-aenial Sculpt Cosmetics

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Big Cases or Small Cases Do a Waxup

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Create a Template from the WaxupTemplate (Clinician’s Choice)

Try on Composite Shades to Evaluate Colors

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Isolate and use dry #00 retraction cords.Air abrade teeth or use a diamond bur.Treat each tooth individually with mylar. Do one tooth at a time.

Etch, bond, first layer of composite then add translucent enamel layer. Re-bond composite if composite is adjusted.

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Use fine diamonds or discs, carbides tend to ditch.

Use fine diamonds or carborundum stones for anatomy.

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Create anatomy and polish so as not to remove the anatomy for better light reflection.

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Jiffy Polishing System (Ultradent)

Use a System that goes from Coarse to Final Shine but be careful tonot remove anatomy

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Jiffy Polishing System (Ultradent)

Absolute Polishers (Parkell)

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Favorite Polishing Discs

Template Developed Bonding

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Disposable Single Use Operative Diamonds

TEXT “DIAMOND3” TO (770)212-2090

FREE!!

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NSK Electric HandpiecesWORLDS #1 SELLING HANDPIECESMALLEST HEAD & SLIMMEST NECKFREE TRIAL OFFER

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Immediately after use, thoroughly wipe template with alcohol pad, dry, bag, and autoclave according to Uveneer template IFU. Do not leave any composite residue on the template in order to maintain translucency and shine.

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CompositeProximalFinishing System

Contents:8 - Orange Serrated Diamond Strip8 - White Serrated Strip8 - Gray Final Polishing Strip

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Veneer Finishing System

Proximal Contour & CleanerContents:8 - Black Diamond Strip8 - White Serrated Strip8 - Blue Serrated Strip8 - Gray Final Polishing Strip

Booth (#3424) to receive a free sample.

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Nowadays good business

is extremely important.

These are my must haves

Implementing various technology and software tools

-Enhance dental care-Lower overhead-Improve performance-Increase Efficiency-Create A Higher Income

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Online Real Data

THE POWER OFACTIONABLE

METRICSDENTAL INTEL

.

New Patients

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NEW PATIENTS

HOW MUCH DO WE REALLY LOVE THEM?

RECAPTURED

PATIENTS

47 $65,114

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218

Before AfterHygiene Re-Appointment

$167,400 increase through Actionable Metrics

Hygiene Re-Appointment

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Delivering Best Dentistry

ACTIONABLE MONITORING DRIVES GROWTH

37%Increase in Production

In One Year!

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DENTAL INTEL

FIND OUT WHERE YOUR BUSINESS IS AT.

CHECK YOUR PRACTICE

FIRST 10 DENTISTS GET A FREE EVALUATION

FREE PRACTICE SNAPSHOT

223

223223

TEXT

“DATA” to

77453 (to waive $1,000 fee)

Free for first 10 people

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224For Your Free Practice Snapshot Go To: www.practicesnapshot.com

and use special code: Todd2017

Remember The Old Appointment Book?

How LONG Did It Take To Answer A Question About Balances, Forgotten

Appointments?

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• Weave

• VOIP Phone system ties into practice management system

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TEAMWORK• Auto confirms appointments and adds to the Practice Management

Software

• Auto Birthday Messages

• Auto propagation of messages

• Easy to implement with minimal time to use.

• Improve business opportunities dramatically

• Cuts down on current employee time by streamlining many tasks

• Saves money on traditional procedures

• Less postage

• Less paper goods

• Less employee time

• 2011 33% reported they did not trust online reviews.

• A recent study reported 88% of people trust online reviews

• 92% or internet users read product reviews

• 89% said it influences their purchases

• 74% of internet users said they would most likely not do business if there was a negative review

• Currently having one bad review is considered normal, but lots of bad reviews is not good.

ONLINE REVIEWS

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WEAVE REVIEWS VIA CELL PHONE MESSAGE

WEAVE REVIEWS VIA CELL PHONE MESSAGE

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WEAVE REVIEWS VIA CELL PHONE MESSAGE

Weave Mobile App

-Same functionality

-From anywhere you have a wifi or cell connection.

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TECHNOLOGY

ONLINE

Efficiency 24/7

Accountability

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Unit 1 Introduction Rapport

Unit 2 Foundation of Rapport

Unit 3Fundamental Techniques in Handling People

Unit 4 Six Ways to Make People Like You

Unit 5 Mirroring & Matching

Unit 6 Outcome of Calls

Unit 7 How to Build Rapport

Module 5 Rapport 2: Personality types

Unit 1 The Know-it-All

Unit 2 The Storyteller

Unit 3 The Easy Peasy

Unit 4 The Rusher

Unit 5 The Informationalist

Unit 6 The Nervous Nelly

Unit 7 The Indecisive

Unit 8 The Price Shopper

Module 6 Rapport 3: Advanced rapport

Unit 1 Empathy

Unit 2 How Long to Build Rapport

Unit 3 VIP Process

Unit 4 Positive Language

Unit 5 Elements of the Rapport Process

Unit 6 Phone Success Quiz #02

Module 7 Engage: Foundation

Unit 1 Introduction to the Engage

Unit 2 What is Engage

Unit 3 Proactive v. Reactive Scheduling

Unit 4 GREAT vs. EAGER Calls

Module 8 Engage: Elements of engaging the patient

• 14 Modules

• Quizes

• Exam

• 13 Modules

• Quizes

• Final Exam

Module 5 Working with Emergencies

Unit 1 Emergencies

Unit 2Scheduling Quiz #01

Module 6 Broken & Changed Appointments

Unit 1 Introduction

Unit 2Broken Appointment Policy

Unit 3Handling Broken Appointments

Unit 4Broken Appointments COSTS

Unit 5What patients must know

Unit 6Important Points

Module 7 Confirmations

Unit 1 Confirmations

Module 8 Early and Late Patients

Unit 1Early and Late Patients

Unit 2Scheduling Quiz #02

Module 9 Next Appointment Updates

Unit 1Next Appointment Updates

Module 10 Patient Reactivations

Developing

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1. Telephone Skills

2. Customer Care Protocols/Scheduling

3. Team’s Role/Training

4. Resource Library

5. 24/7

97% of offices don’t train.

(954) 323-2220

Inquire with “Heather” for a $200 Discount

Google Website Speed, Responsive Design and Build Issues/Code

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www.BLUX.com

Click VERIFY

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Type your website into the test area

Type your website into the test area

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Ngenys.com

Coming Soon!

FREE HANDOUTS, MARKETING INFORMATION, OFFERS, SOCIAL MEDIA LINKS & MORE

www.DENTOOLZ.com

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Thank you!

Todd C. Snyder, DDS, FAACD, FIADFE(949) 643-6733

doc@tcsdental.com

www.aestheticdentaldesigns.comwww.drtoddsnyder.com