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SPRING ISSUE 2013VOL. 45, NO. 3
Bulletin
is PROUD TO sPONsOR
T h e L a b o r a t o r y N e t w o r k
DSG Americus Dental Lab is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement. The current term of approval extends from 6/1/12 to 5/31/14.
DATES/LOCATIONS:Friday, September 13, 2013Frederick Meijer Gardens and Sculpture Park1000 East Beltline Ave NEGrand Rapids Charter Township, MI 49525
REGISTRATION & CONTINENTAL BREAKFAST:8:00 a.m. – 9:00 a.m.
PROGRAM:9:00 a.m. – 3:30 p.m.
HOW TO REGISTER:Online – register at dentalservices.net/davisramseyBy phone – contact Sue Isenga at 616-261-9191By email – [email protected]
PAYMENT:Payments can be made in advance or in person by check or credit card ONLY. If mailing a check, please include your first and last name, name of your practice, contact information, and the names of attendees with your check. Make checks payable to DSG Davis Laboratory and mail to:DSG Davis Dental LaboratoryATTN: Sue Isenga5830 Crossroads Commerce PkwyWyoming, MI 49519
COST:$225 per doctor | $125 per staff memberRSVP by September 6, 2013.RegisteR by July 1st and Receive $25 off youR tuition!Registration fees include continental breakfast, luncheon and handout materials and an open pass to the Frederick Meijer Gardens until 5:00 pm on the day of the seminar.
TERMS AND CONDITIONS:• Registrations are not considered final until payment is received in full• DSG Davis Laboratory reserves the right to cancel seminars that do not meet
minimum enrollment expectations• The registration fee will be refunded in full if DSG Davis Laboratory cancels the seminar• Attendee will receive 100% refund of the registration fee if attendee cancels four
weeks or more prior to the seminar
Course overview:Knowledge of dental materials and the most advanced products is necessary to maximize the success of your practice. This presentation is appropriate for dentists and their clinical staff members.
• IPS e.max®—whats the latest and greatest?• Full-contour zirconia is here to stay!• Understanding the Cadent™ iTero™ and the new True Definition Scanner from
3m™ and the benefits of both systems.• Incorporating the use of these scanners in implant dentistry.• Highlighting the latest ceramic systems, including the pros and cons of each.• Understanding the latest cementation options and their indications.• Addressing the latest adhesives—what is working and what is not.• Restorative and biological guidelines for implant dentistry.
Dr. Christopher ramsey, DmDChristopher D. Ramsey was raised and currently practices in Jupiter, Florida. His practice focuses on comprehensive esthetic and restorative dentistry. Dr. Ramsey received his dental degree from Temple University school of Dentistry in Philadelphia, Pennsylvania in 1999.
Dr. Ramsey is an accredited member of the American Academy of Cosmetic Dentistry and is also an Alumnus of the Pankey Institute in Key Biscayne, Florida. He is on the editorial review boards for the AACD Journal of Cosmetic Dentistry and the Journal of Implant and Restorative Dentistry. He has published numerous articles on customer service related topics, adhesive technology and cosmetic dentistry in several publications such as the Journal of Implant and Restorative Dentistry, Journal of Esthetic and Restorative Dentistry, PPAD, Dentistry Today, Contemporary Esthetics, Signature, and the Dental Products Report. Dr. Ramsey is a product consultant for The Dental Advisor, and to numerous dental manufacturers, garnering greater insight into the newest materials and techniques. He also has the unique opportunity to lecture both nationally and internationally on cosmetic dentistry and the elements needed to create successful, esthetic-based practices.
Dr. Ramsey takes over 200 hours of continuing education a year to stay on the cutting edge of cosmetic dentistry, which is a rapidly changing profession. He is the past President of The Florida Academy of Cosmetic Dentistry.
Predictable ProceduresFrom A To Z
LUNCHEON:12 p.m. – 1 p.m.
DSG Davis Dental Laboratory5830 Crossroads Commerce PkwyWyoming, MI 49519
PReSenTeD By: Dr. Chris ramsey FRIDAy, SePTemBeR 13, 2013 | 6 Ce CReDITS
T h e L a b o r a t o r y N e t w o r k
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 1
Contents
President’s Message ..................................................................................................... 2
Editor’s Thoughts ........................................................................................................ 3
Trustee Report ............................................................................................................. 4
A Brief Primer and Literature Review on Crown Surgery ........................................ 8
Technically Speaking ...................................................................................................16
Practice Management ..................................................................................................20
Classified Ads ...............................................................................................................22
Advertiser Index ...........................................................................................................23
WMDDS Summer CE Program ..................................................................................24
About the Cover
WMDDS Tooth Time event, February 2013.
Photo courtesy of Dr. David Huyser, chairperson of the Tooth Time event.
Mission StatementThe Bulletin is the newsletter of the WMDDS and its mission is to inform the membership of
upcoming and recent events, state & local issues related to dentistry, and as a forum for its officers,
representatives, and members to discuss appropriate topics of interest to the membership.
Communication & Advertising PolicyThe Bulletin will publish submitted articles from members and others that relate to the practice of
dentistry, small business, social, or political issues affecting dentists, or other subjects of interest to
the membership. All published items are subject to space restrictions and the community standards
of the WMDDS. The editors reserve the right to reject any article or advertisement deemed
inappropriate and to edit submissions as they see fit.
Submission & Publication Policy: Articles and advertisements must be submitted no
later than the 1st of the month preceding publication date. The Bulletin has six publications:
the winter issue, spring issue, summer issue, directory issue, fall issue, holiday issue. Direct
submissions or correspondences to:
Dr. Jeffrey S. Smith • 3050 Ivanrest SW, Suite B • Grandville, MI 49418
Phone: 616.531.1554 FAX 616.531.6947 • Email: [email protected]
Include “Newsletter” in the subject line
Editor Dr. Jeff Smith
Associate Editors Dr. Seth Vruggink Dr. Derek Draft Dr. Aric Smith Dr. Brian Licari
Advertising Editor Elaine Fleming Executive Secretary WMDDS 511-F Waters Building Grand Rapids, MI 49503 (616) 234-5605 [email protected]
West Michigan District Dental Society Executive Board 2012-2013 President Dr. Tyler Wolf President-Elect Dr. Margaret Gingrich Vice President Dr. Samuel Bander Secretary-Treasurer Dr. Kathleen Ellsworth Editor Dr. Jeff Smith Immediate Past President
Dr. Larissa Bishop
Directors Dr. Steve Conlon Dr. Leonard Bartoszewicz Dr. Brian MulderArea Representatives
Kent County Dr. Michael Palaszek Ionia-Montcalm
Dr. John O’Donald
County Mecosta County Dr. Erick Perroud Ottawa County Dr. Meredith Smedley
MDA IV District Dr. Brian Cilla Trustees Dr. Colette Smiley
Big Rapids Dental Study Club OfficersPresident Dr. Erick Perroud Vice President Dr. Christa SternSecretary Dr. Christa SternTreasurer Dr. Erick Perroud
Holland-Zeeland Dental Society OfficersPresident Dr. Meredith Smedley Treasurer Dr. Robert Ankerman Secretary Immediate Past President
Ionia-Montcalm Dental Study Club OfficersPresident Treasurer Dr. Kirkwood Faber
Kent County Dental Society OfficersPresident Dr. Norman Wilhelmsen Vice President Dr. Michael Palaszek Secretary Dr. Kathryn SwanTreasurer Dr. James Papp
West Michigan Dental Foundation OfficersPresident Dr. John Marshall Vice President Mrs. Wendy Mc Ginnis Secretary Mrs. Carol Klein Treasurer Mr. Joe Van Laan
The Bulletin of the West Michigan Dental Society is published six times a year (the winter issue, spring issue, summer issue, directory issue, fall issue, and holiday issue). The opinions expressed in The Bulletin are not necessarily the opinions of the West Michigan District Dental Society.
Contributions to The Bulletin are welcome and should be addressed to The Bulletin Editor, 3050 Ivanrest SW, Suite B, Grandville, MI 49418. Requests for purchase of advertising space should be directed to the Advertising Editor, Elaine Fleming, (616) 234-5605. The deadline is the 1st of the month prior to publication.
© 2012-2013 West Michigan District Dental Society Bulletin
is PROUD TO sPONsOR
T h e L a b o r a t o r y N e t w o r k
DSG Americus Dental Lab is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state of provincial board of dentistry or AGD endorsement. The current term of approval extends from 6/1/12 to 5/31/14.
DATES/LOCATIONS:Friday, September 13, 2013Frederick Meijer Gardens and Sculpture Park1000 East Beltline Ave NEGrand Rapids Charter Township, MI 49525
REGISTRATION & CONTINENTAL BREAKFAST:8:00 a.m. – 9:00 a.m.
PROGRAM:9:00 a.m. – 3:30 p.m.
HOW TO REGISTER:Online – register at dentalservices.net/davisramseyBy phone – contact Sue Isenga at 616-261-9191By email – [email protected]
PAYMENT:Payments can be made in advance or in person by check or credit card ONLY. If mailing a check, please include your first and last name, name of your practice, contact information, and the names of attendees with your check. Make checks payable to DSG Davis Laboratory and mail to:DSG Davis Dental LaboratoryATTN: Sue Isenga5830 Crossroads Commerce PkwyWyoming, MI 49519
COST:$225 per doctor | $125 per staff memberRSVP by September 6, 2013.RegisteR by July 1st and Receive $25 off youR tuition!Registration fees include continental breakfast, luncheon and handout materials and an open pass to the Frederick Meijer Gardens until 5:00 pm on the day of the seminar.
TERMS AND CONDITIONS:• Registrations are not considered final until payment is received in full• DSG Davis Laboratory reserves the right to cancel seminars that do not meet
minimum enrollment expectations• The registration fee will be refunded in full if DSG Davis Laboratory cancels the seminar• Attendee will receive 100% refund of the registration fee if attendee cancels four
weeks or more prior to the seminar
Course overview:Knowledge of dental materials and the most advanced products is necessary to maximize the success of your practice. This presentation is appropriate for dentists and their clinical staff members.
• IPS e.max®—whats the latest and greatest?• Full-contour zirconia is here to stay!• Understanding the Cadent™ iTero™ and the new True Definition Scanner from
3m™ and the benefits of both systems.• Incorporating the use of these scanners in implant dentistry.• Highlighting the latest ceramic systems, including the pros and cons of each.• Understanding the latest cementation options and their indications.• Addressing the latest adhesives—what is working and what is not.• Restorative and biological guidelines for implant dentistry.
Dr. Christopher ramsey, DmDChristopher D. Ramsey was raised and currently practices in Jupiter, Florida. His practice focuses on comprehensive esthetic and restorative dentistry. Dr. Ramsey received his dental degree from Temple University school of Dentistry in Philadelphia, Pennsylvania in 1999.
Dr. Ramsey is an accredited member of the American Academy of Cosmetic Dentistry and is also an Alumnus of the Pankey Institute in Key Biscayne, Florida. He is on the editorial review boards for the AACD Journal of Cosmetic Dentistry and the Journal of Implant and Restorative Dentistry. He has published numerous articles on customer service related topics, adhesive technology and cosmetic dentistry in several publications such as the Journal of Implant and Restorative Dentistry, Journal of Esthetic and Restorative Dentistry, PPAD, Dentistry Today, Contemporary Esthetics, Signature, and the Dental Products Report. Dr. Ramsey is a product consultant for The Dental Advisor, and to numerous dental manufacturers, garnering greater insight into the newest materials and techniques. He also has the unique opportunity to lecture both nationally and internationally on cosmetic dentistry and the elements needed to create successful, esthetic-based practices.
Dr. Ramsey takes over 200 hours of continuing education a year to stay on the cutting edge of cosmetic dentistry, which is a rapidly changing profession. He is the past President of The Florida Academy of Cosmetic Dentistry.
Predictable ProceduresFrom A To Z
LUNCHEON:12 p.m. – 1 p.m.
DSG Davis Dental Laboratory5830 Crossroads Commerce PkwyWyoming, MI 49519
PReSenTeD By: Dr. Chris ramsey FRIDAy, SePTemBeR 13, 2013 | 6 Ce CReDITS
T h e L a b o r a t o r y N e t w o r k
ince the plea for you to help people based on the
human condition has fallen on deaf ears, I will take
another tack…
You do know that there are way too many people in this
very community that are without the means to have dental
care.… Right? Please tell me you are aware of this.
Wouldn’t you rather choose to volunteer your time rather
than be made to? Or what about having someone trained to
do your job for you if you will continue to fail to step up to
the plate? I would think that you would have seen the writing
on the wall by now. If you don’t know what the term “access
to care” means to our profession, than you need to pull your
head out of that dark space and open your eyes. Have you
not witnessed already what is going on politically with health
care on a national level? Do you understand that dentistry is a
logical eventuality to be included with this downhill snowball?
Do you not understand that the very institutions that trained
you are now looking to instruct people that will be able to do
many of the things that you do – but more cheaply, and with
much less education?
I truly hope that this is not the first time that you are think-
ing about these things.
I know that there are many of you out there who are
already doing a lot. Whether it is within your own practice
or taking advantage of opportunities within your community
to give back, it is all an accomplishment that you should be
proud of. Unfortunately, you add up to a very small percent-
age of practicing dentists in this area. You are not to whom I
am speaking.
If you don’t know whether I am addressing you right now
or not, then I probably am. You need to start giving of your
time, and start making more of a difference.
At the risk of sounding dramatic and cliché, strong pow-
ers are at work to forge ahead with a “solution” to this access
problem – with or without our input as dental professionals.
This is being backed and funded by some entities with very
large and deep pockets. The research, testing, and training
are occurring as I write this; at both Schools of Dentistry in
Michigan.
Hopefully you are now asking, “What can I do?”
Here’s a list which is completely off the top of my head, in
no particular order, and in no way all inclusive:
• Mel Trotter Ministries
• Ottawa County Health Department – Miles of Smiles
Dental Mobile Unit
• Adult Dental Services Program
• Donated Dental Services
• MOM (Mission of Mercy) Project
We all have busy jobs, schedules, families, etc. You know that
you have no real reasons not to volunteer… only excuses.
Thanks for reading. It has been my privilege to serve as
your WMDDS President this year. Any questions, comments
or concerns, please feel free as always: [email protected] or
457-4600.
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 20132
P R E S I D E N T ’ S M E S S A G E
What is Needed Expected of YouBy Tyler A. Wolf, DDS, WMDDS President
S
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 3
f memory still serves me correctly, it seems that back in
the dark ages after graduating from dental school and
opening up an office, most of my patients were reason-
ably healthy and the amount of medications that they took
regularly could be kept on a scrap of paper the size of a small
grocery list. Fast forward almost three decades, my patients
and I have grown older together, and for many, that short list
has become a thin book. As our patients routinely take more
and more prescription and non-prescription medications,
we have to be more mindful of how some of these drugs can
affect many of the procedures that we perform daily.
While the scope of all of the possible interactions between
dentistry and the drugs that our patients use (and may abuse)
is the subject of a textbook, this short article is meant to
focus on some of the more common “blood thinners” that
we see on our patient’s health histories. I’m sure that almost
everyone reading this has at some time successfully done what
appeared to be a routine extraction, or some other simple sur-
gical procedure, only to be surprised by how difficult it was,
or how long it took to get adequate hemostasis. In some of
these cases, the patient may not have been taking any known
thinner at all. As our patients mature, some are prescribed
anti-clotting agents in conjunction with histories of stroke,
heart attacks, atrial fibrillation, or prosthetic heart valves.
Many also receive these medications after the placement of
vascular stents or artificial joints.
While we learned the intrinsic and extrinsic clotting cas-
cades at one time, the bottom line is that there is no single
test that we can order or request be ordered for our patients
that covers all of the possible hemostasis complications that
can occur after dental surgical procedures. Some of the more
Life (and the Practice of Dentistry) Isn’t Getting Any SimplerBy Dr. Jeff Smith, WMDDS Editor
E D I T O R ’ S T H O U G H T S
common tests measure antiplatelet activity, which are sepa-
rate and unrelated to tests which measure the intrinsic and
extrinsic coagulation pathways.
Aspirin, NSAIDS, Plavix (clopidogrel), Ticlid (ticlopidine),
and Effient (prasugrel) all affect platelet function. Tests to
review would include: the Platelet Function Assay and Platelet
Count. Verify Now Aspirin is a new test that documents the
presence or absence of effective aspirin inhibition of platelet
activity. The Verify Now P2Y12 test measures platelet inhibi-
tion in patients using Plavix or related drugs.
Many of our patients are taking Coumadin (warfarin).
This drug affects vitamin K dependent clotting factors. The
Prothrombin Time (PT), and International Normalized Ratio
(INR) tests measure the extrinsic coagulation pathway, and
are appropriate for this medication.
Pradaxa (dabigatran) is a newer oral medication which
inhibits thrombin formation. It was introduced because
it eliminates the need for continuous PT/INR monitoring
which is usually necessary for patients taking Coumadin (war-
farin). The Activated Partial Thromboplastin Time (aPTT) or
Thrombin Time (TT) tests are used to measure its anticlotting
effect. PT/INR tests will not measure the effect of Pradaxa.
Many of the patients who take these anticlotting drugs may
be too sick systemically to undergo what would otherwise be
simple outpatient surgeries done in our offices. If there is any
doubt as to your patient’s health status, or you are uncertain
whether there may be a health risk or bleeding problem after
a procedure that you are recommending, do not hesitate to
contact the patient’s physician before performing the pro-
cedure. DO NOT advise your patient to discontinue taking
any physician prescribed medications in an attempt to better
control post-operative bleeding. Consider your local medical
laboratories as an information resource. They are more than
happy to answer any questions you may have concerning the
appropriate tests and ranges for your patients’ medications
and the procedures you are recommending. Finally, as new
medications arrive on the market and show up unrecognized
in our patients health histories and history updates, don’t be
afraid to ask your patient what the drug is for, why they are
using it, and what their daily dosage is.
I
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 20134
s I write this current report, we are in the beginning
stage of March Madness (basketball and Washington,
DC). The MDA Annual Session is just around the
corner. This year’s event theme is the “Spirit of Michigan”
and will be in Novi on April 17-20. There are three days of
CE courses and nearly 200 exhibits. Please make plans to
attend this meeting. Of special note, Dr. Norm Palm will be
our incoming MDA President. May it be smooth sailing for
the next year. However, we all know that Norm will be ready
for anything that comes his way. Wish him success with his
tenure as the President.
This report contains highlights from the February Board of
Trustees (BOT) meeting.
MDA BudgetDetermining the annual budget for the MDA is a complex
process. Non-dues revenues, generated by the MDA Insurance
and Financial Group (IFG), are an important component of
the MDA annual budget. We are very fortunate that MDA-
IFG has experienced continued, ongoing growth over the
years. The revenues generated by these programs have pro-
vided significant dues relief for our members. At the pres-
ent time, the projected MDA budget is essentially balanced.
However, we are at a crossroad with the unknown. The
insurance exchanges dictated by the Affordable Health Care
Act may, or may not, impact a significant portion of our non-
dues revenues. As a consequence, at the most recent BOT
meeting, there was much discussion and deliberation regard-
ing the upcoming MDA budget. The Board has asked that
background information be sent to the 2013 MDA House of
Delegates (HOD) so that the delegates understand the timing
Highlights from February BOT MeetingBy Dr. Brian Cilla, MDA Trustee
and complexity of the issues facing the MDA with regard to
the proposed 2014 budget, the dues amount, and the need for
flexibility in the decision-making process. A resolution will be
forwarded to the 2013 HOD which would grant the MDA BOT
the authority to set the 2014 dues at up to the current 2013 dues
amount, for the purpose of maintaining a balanced budget.
MDA MembershipAt our last meeting, it was resolved that, for working life
members, the annual dues and contributions toward any
MDA assessments shall be 75% of an active member. This
policy is consistent with current ADA policy.
Nationally, the MDA remains at the forefront in providing
membership value. According to the MDA’s 2012 year-end
membership report, our Association ended last year with a
76.5% market share, up .3% from year-end 2011. 79.2% of
dentists under the age of 40 are members of the MDA.
MDA Governance Our MDA by-laws require a periodic review of governance.
At the present time, the MDA is operating with a governance
structure modeled in the 1970s. As a consequence, a work
group has been formed to review the MDA. Dr. Michael
Gallery is the consultant and facilitator for this group. A
meeting was held in January in order to begin discussions
on potential solutions to where MDA performance is versus
where the MDA should be (gap analysis). Recommendations
have not yet been formulated because there are many possible
solutions and the work group wants input from the House
and membership regarding the performance requirements
and gaps. As a preliminary step, the 2013 HOD will be asked
to adopt resolutions regarding these parameters. As part of
this process, Drs. Michael Gallery and Joanne Dawley will
provide a presentation to the House and there will be an
opportunity to ask questions. At the reference committee
hearing there will be testimony on the performance require-
ments and gaps. Once feedback is received from the House,
the work group will then be able to formulate solutions and/
or recommendations. These will be presented at the June BOT
meeting. It is anticipated that there will be a special meeting of
the House of Delegates on September 20, 2013 for the specific
purpose of governance review.
A
T R U S T E E R E P O R T
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 5
Department of Community Health The director of Michigan Department of Community Health
(MDCH), Mr. Jim Haveman, provided the BOT with an
update on the department. Mr. Haveman reviewed the
MDCH budget recommendation for 2014 and strategic
priorities. It was reported that Medicaid expansion is sup-
ported by Governor Snyder. This expansion will add 370,000
to Medicaid and provide health care for low income people.
Initially, 100% of the costs for this expansion will be funded
by the federal government for the first three years. At the
present time, there are 1.2 million uninsured individuals in
Michigan. It is anticipated that increased coverage will keep
these individuals out of the emergency rooms and also pro-
vide for medical homes. Adult dental care is not included
in this plan. As part of the process, a Federal/Sate Insurance
Exchange will be established. The Federal government will
be providing $30M to begin working on the Exchange. If
Michigan does not act on the $30M, the Federal government
will run the exchange and bill Michigan for costs associ-
ated with running the exchange. In order for this to occur,
Michigan must first create a new computer system. Michigan
will spend about $150M to upgrade its current system to be
compatible with the new exchange. It is anticipated that it
will take 3-4 years to get all of the kinks out of the system. A
question was raised as to how the department plans to work
with the Medicaid population in order for these individuals
to take personal responsibility for their own health care. Mr.
Haveman is aware that solutions for this complex problem are
difficult and that any and all ideas are welcome. He asked that
input be provided to Bill Sullivan, who can then relay them
to MDCH.
Healthy Kids Dental The Governor, on February 7, presented his 2014 state
budget. Previously, the Governor has proposed expanding
Healthy Kids Dental (HKD) program to the entire state.
Due to budget realities, the plan has been for an incremental
phase-in of HKD. There is an expected completion date of
2016. Ten counties were included with the first expansion in
2013. The proposed 2014 budget for HKD includes $11.6 mil-
lion, of which $3.9 million is from the state and $7.7 million
will be federal. It is anticipated that the following counties
will be added to HKD: Ingham, Ottawa, and Washtenaw. The
budgets for Donated Dental Services will remain same as last
year ($151,000). Adult Dental Medicaid will receive $7M in
state funds and $14M federal matching funds.
Mission of Mercy (MOM)Dr. Stephen Harris, chair of the MOM project, provided the
Board with an update on the 2013 project. The event will be
held June 7-8, 2013 at the Ryder Center at Saginaw Valley
State University. The MDA has exceeded its financial goals for
this 2013 event. Monies remaining will be transferred to the
2014 event. There are currently over 400 volunteers. Dental
volunteers are still needed. Dentists can sign up to volunteer
from the MDA’s website.
Future MOM projectsThe MDA Board has voted to do another MOM in May of
2014. If everything goes as planned, it will be held May 29
to June 1 at Ferris State University. It is anticipated that the
MDA Foundation will again partner with the MDA on this
venture. The MDA will be monitoring the success of these
projects in order to determine the frequency and locations
for future events.
Legislative AdvocacyEveryone has received a mailing from the MDA regarding the
importance of legislative advocacy. The MDA is encouraging
our members to be active in the political process. There is easy
access to contact information on the MDA website.
We have our next WMDDS Legislative Breakfast on
Friday, April 26, 2013 at Frederik Meijer Gardens & Sculpture
Park. Please mark your calendar and make plans to attend this
year’s WMDDS Legislative Breakfast. This is an important
opportunity for you to meet local legislators and express your
views and concerns on the issues that affect dentistry. Please
make every effort to attend. Dentistry’s voice needs to be
heard by our local representatives.
Since access to care has become such a prevalent local
and national topic of discussion, the MDA plans to hire our
current intern, Stephanie Olds, to promote the many good
things that dentists are doing in their communities. She will
be attending local components to cover access events and
T R U S T E E R E P O R T
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 20136
continue to send MDA Twitter feeds. Additionally, Stephanie
will work with local components on creative marketing
opportunities.
Topics of Local InterestThe Kent County Health Department (KCHD) has reported
that the funding is in place to begin construction of the new,
ten-chair dental clinic in Kentwood. Spectrum Health has
funded a “dedicated chair” at the KCHD Clinic for Spectrum
Emergency Department dental referrals.
Blue Cross has given a $200,000 grant to establish a new
dental program at the Federally Qualified Health Center oper-
ated by Saint Mary’s Health Care. The FQHC clinic, operated
by the Peoples Health Centers of Michigan will include five
T R U S T E E R E P O R T
2013 New Dentist Forum Golf OutingFriday, September 6 — Noon Shotgun
(the first week back at school when you can roll a bowling ball through our offices and not hit anyone!)
Quail Ridge Golf Course in Ada
Loads of prizes, contests and fun!
Registration forms to be mailed in June
For sponsorship information, contact Devin Norman: [email protected]
operatories and will be located at Hope Network’s campus
on 36th Street. The People’s Health Centers of Michigan is a
non-profit collaboration of Saint Mary’s Health Care, Hope
Network, and Metro Health.
FinishAs always, I welcome any questions, concerns and/or com-
mentary regarding the activities of the MDA. Do not hesitate
to call, write or e-mail ([email protected]). In the meantime,
enjoy the longer days and any of our nice spring weather.
Legislative Breakfast
Friday, April 26, 2013Frederik Meijer Gardens & Sculpture Park
1000 East Beltline NEGrand Rapids, MI 49525
Please mark your calendar and make plans now to attend the WMDDS Legislative Breakfast.
This is an important opportunity for WMDDS dentists and local legislators to meet and express views
and concerns on the issues that affect dentistry. Please make every effort to attend.
To reserve your place, please complete and return the attached form by April 18, 2013.
Name
Email address
Breakfast Buffet will be served starting at 8:00 am
Cost: $16 per person
Please make check payable to: West Michigan District Dental Society
Return by April 18, 2013 to:
West Michigan District Dental Society
161 Ottawa Avenue NW Suite 511-F
Grand Rapids, MI 49503
Questions? Contact Elaine Fleming
616.234.5605 | [email protected]
or
Dr. Steve Dater, WMDDS Legislative Chairperson
616.866.0869 | [email protected]
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 20138
ow often has one of your patients asked you if
there is anything that can be done to make their
teeth look larger or their smile less gummy? We all
have patients with short clinical crowns and/or a high lip line
that exposes a broad band of gingival tissue when they speak
or smile. Crown lengthening surgery can be done to increase
the length of the maxillary teeth in an apical direction, and at
the same time decrease the amount of visible gingiva. Crown
lengthening surgery is also used in situations of sub-gingival
decay, crown fractures, altered passive eruption, severe attri-
tion, or where the height of the crown is deemed inadequate
for retention without extending the restoration deep into the
periodontal tissues.1,2,3
In 1961, Garguilo defined the biologic width as the com-
bined width of the epithelial and underlying connective tissue
attachments that comprise the dentogingival junction. Since
each averaged 1mm, the biologic width was about2mm with a
gingival sulcus about 0.7mm deep.4 Nevins and Skurow included
the gingival sulcus depth, so the biologic width became ap-
proximately 3mm.5 Any impingement of the biologic width
by a restorative margin can result in gingival inflammation,
pocket formation, and alveolar bone loss.6,7,8 Gingival health
and form after placing a sub-gingival restoration depends
upon non-impingement of the biologic width, tooth shape,
and a smooth, continuous emergence profile that does not
disrupt the cervical wall of the supra-crestal gingival tissue.
When crown lengthening is done to alter the shape and
size of maxillary teeth, it can involve gingivectomy, osseous
surgery, orthodontic extrusion, or any combination of these.
Before proceeding with any periodontal or restorative treat-
ment, the following factors must be considered:
A Brief Primer and Literature Review on Crown Lengthening SurgeryBy Dr. Jeff Smith, WMDDS Editor
C L I N I C A L N E W S
1. Location of the gingival margin in relation to the CEJ and
alveolar crest,
2. Crown to root ratio, short tapering roots, and alveolar
bone relationships,
3. The size and shape of the upper lip,
4. The location of the lip line during speech and relaxed smiling,
5. Aesthetics,
6. Predictability and maintainability, and
7. Comparison of the adjacent periodontium to provide
a continuous transition between lengthened and non-
lengthened teeth.9,10
If the width of the free gingiva is greater than 1mm (i.e. the
clinical crown is shorter than the anatomical crown), and the
patient displays a periodontium of the thin biotype, then full
exposure of the crown may be possible with gingivectomy.
If the periodontium is of the thick biotype, then an apically-
positioned flap (with osseous surgery if necessary) should be
done. In patients with short anatomical crowns, more exten-
sive bone reduction and root exposure may become neces-
sary. Crowns or veneers then must be used to increase the
apical-incisal dimension of the clinical crowns.
Patients with normal occlusion and incisal guidance should
not have the positions of their incisal edges altered. Their
crowns are made longer by surgically exposing root structure,
and the cervical margins of the restorations are placed on the
roots. Crown length is then limited by the aesthetic height to
width ratio of the teeth. In patients who exhibit an anterior
overbite, the incisal edges of the teeth may be repositioned
apically in addition to the cervical margins to preserve an
ideal height to width ratio of 1.2 to 1 without interfering with
incisal guidance.11
Bony recontouring alone may not be the best choice for
single teeth, especially in the maxillary anterior region where
symmetry is critical, or where removal of bone from adjacent
teeth should be avoided. In these cases orthodontic extrusion
can be used to bring the tooth down to a distance equal to or
slightly greater than the portion of sound tooth structure that
will be exposed with subsequent osseous surgery. This extru-
sion can be slow or rapid.12,13,14,15 After bony crown lengthen-
ing is completed on extruded teeth, the final position of the
free gingival margin is harmonious with the adjacent teeth.
H
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 9
When crown lengthening is performed, a 3 to 4mm dis-
tance between the alveolar crest and the restorative margin is
essential to allow the necessary space for healthy dentogingi-
val tissue. In the absence of periodontal disease, transcrevicu-
lar probing or “sounding” with local anesthesia can be done
to insure that there is adequate distance between the proposed
restorative margin and alveolar crest after crown lengthening
is completed. Margins should be placed halfway down the
sulcus or about ½mm if possible.16
Bragger and others have demonstrated that a 3mm biologic
width remains stable up to 6 months.17,18 Other studies have
reported that there can be 1mm or more gingival “rebound”
coronally, especially in thick tissue biotypes.19,20 In aesthetic
cases, it may be prudent to keep patients in temporaries for an
adequate time period (normally 12-14 weeks) to insure that
the free gingival margins are in their final position before final
restorative margins are placed and impressions taken. Wound
healing studies in monkeys suggest that the biologic width
re-establishes itself following crown lengthening procedures.
The junctional epithelium will migrate to the level of root
planning, and the space for supra-crestal connective fibers is
created by resorption of alveolar bone.21
When crown lengthening is done, the final alveolar contour
should parallel the CEJ or proposed margin of the restoration.
On posterior teeth the alveolar bone should be relatively flat,
whereas the bone around anterior teeth will assume more of
a “saddle” form, being more coronal interproximally, as it
circumscribes the tooth.22
One of the most difficult challenges in periodontics and
aesthetic dentistry is closing or repairing areas where the
papillae have receded or are not present due to excessive
interproximal distance between the teeth. There are no pre-
dictable ways to graft or rebuild these papillae once they are
gone. Tarnow stated that if the interproximal contact points
of the teeth are within 5mm of the alveolar bone, the papillae
will usually regenerate and fill any “black triangles.” 23 This
should be kept in mind during the surgical phase so that no
more interproximal bone is removed than necessary. Black
triangles can be closed by raising the interproximal contacts of
the crowns apically, however, this can cause the teeth to look
unaesthetically “square.” This is especially true in patients
whose natural crowns are more round or “bell” shaped.
In an ideal aesthetic situation in the anterior maxilla, the
height-to-width ratio of the crowns should be between 1-1.2
to 1. The central incisors should be symmetrical, and in line
in height and position. The heights of contour at the cervical
areas should be located at the disto-labial line angle to avoid
the appearance of “chiclet-like” teeth. The free gingival mar-
gins of the cuspids and centrals should all be on one line that
parallels another line bisecting the patient’s pupils. The free
gingival margins of the laterals should be 1-1.5mm incisal to
those of the cuspids and centrals.24
Finally, when treatment planning a case for aesthetic
crown lengthening, it is helpful to gather photos of your
patient while smiling, when their lip is at rest, as well as with
cheek retractors. Upper and lower study models are useful
for determining incisal guidance. A diagnostic wax up on
the models can also be used to present the proposed case to
the patient. Radiographs are also necessary to verify that if
osseous surgery is required for the case, that the crown to
root ratio of the teeth to be lengthened, or the bony support
around adjacent teeth is not compromised.
Bibliography1. Smukler H, Chaibi M, Periodontal and Dental Considerations in
Clinical Crown Extension: A Rational Basis for Treatment. IJPRD 1997:
17:465-477.
2. Carranze, F. (1990) Glickman’s Clinical Periodontology, 7th Edn.
Philadelphia: W.B. Saunders Company, pp. 921-923.
3. Cohen, E. (1994) Atlas of Cosmetic and Reconstructive Periodontal
Surgery, 2nd Edn. Philadelphia: Lea and Febiger, pp. 263-383.
4. Garguilo A, et al, Dimensions of the Dentogingival Junction in Humans.
JPerio 1961; 32:261.
5. Nevins M, Skurow A, The Intracrevicular Restorative Margin, the
Biologic Width, and the Maintenance of the Gingival Margin. IJPRD
1984; 4:31.
6. Newcomb G, The Relationship Between the Location of Subgingival
Crown Margins and Gingival Inflammation. JPerio 1974; 45:151-154.
7. Bensimon G, Surgical Crown – Lengthening Procedure to Enhance
Esthetics. IJPRD 1999; 19:332-341.
8. De Waal H, Castelluci G, The Importance of Restorative Margin
Placement to the Biologic Width and Periodontal Health. Part 1. IJPRD
1993; 13:461-471.
9. Lindhe, J. (1989) Textbook of Clinical Periodontology, 2nd Edn.
Munksgaard, pp. 487-496.
10. Rosenberg E, Garber D, Tooth Lengthening Procedures. Compen.
Contin. Ed. Gen. Dent. 1980; 1:161.
C L I N I C A L N E W S
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201310
11. Garber D. (1987) Periodontal Esthetics Problem Solving-Unique
Problems Require Unique Solutions. Presentation, D. Walter Cohen
Periodontal Symposium, University of Pennsylvania, Philadelphia.
12. Pontoriero R, et al, Rapid Extrusion with Fiber Resection: A combined
Orthodontic-Periodontic Treatment Modality. IJPRD 1987; 7:30-43.
13. Reitan K, Clinical and Histologic Observations on Tooth Movement
During and After Orthodontic Treatment. American Journal of
Orthdontics 1967; 53:721-745.
14. Ingber J, Forced Eruption: Part 1. A Method of Treating Isolated One
and Two Wall Infrabony Osseous Defects – Rationale and Case Report.
JPerio. 1974; 45:199-206.
15. Guilford H, et al, Vertical Extrusion: A Standardized Technique.
Compen. Contin. Ed. Gen. Dent. 1984; 7:562-568.
16. Ingber J, et al, The ”Biologic Width”, a Concept in Periodontics and
Restorative Dentistry. Alpha Omegan 1977; 70:62-65.
17. Lanning S, et al, Surgical Crown Lengthening: Evaluation of the Biologic
Width. JPerio 2003; 74:468-474.
Mission Statement: An organization dedicated to the improvement of oral health through the
financial support of education and service programs to address the needs identified by the dental
profession and the communities it serves in Kent, Ottawa, Ionia, Mecosta and Montcalm counties.
MARK YOUR CALENDAR
West Michigan Dental FoundationAnnual Golf Outing
Friday May 31, 2013 Egypt Valley Country Club
Watch for registration forms to arrive in April.
18. Bragger U, Surgical Lengthenung of the Clinical Crown. J. Clin. Perio.
1992; 19:58.
19. Pontoriero R, Carnevale G, Surgical Crown Lengthening: A 12-Month
Clinical Wound Healing Study. JPerio 2001; 72:841-848.
20. De Waal H, Castelluci G, The Importance of Restorative Margin
Placement to the Biologic Width and Periodontal Health. Part 2. IJPRD
1994; 14:70-83.
21. Oakley E, et al, Formation of the Biologic Width Following Crown
Lengthening in Nonhuman Primates. IJPRD 1999; 19:528-541.
22. Davarpanah M, et al, Restorative and Periodontal Considerations of
Short Clinical Crowns. IJPRD 1998; 18:424-433.
23. Tarnow D, et al, The Effect of the Distance From the Contact Point to
the Crest of Bone on the Presence or Absence of the Interdental Dental
Papilla. JPerio 1992; 63:995-996.
24. Lowe R, Esthetic Restoration of the Maxillary Anterior Region: A Case
Report. IJPRD 1989; 9:354-363.
C L I N I C A L N E W S
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Join your colleagues for great social events, a variety of topics and speakers and nearly 200 exhibits.
New this year — one hour “Hot Topic” sessions —more information coming soon.
SPEAKERS INCLUDE:
Scott Benjamin, DDSJoseph Best, DDS, PhDM. Douglas Campbell
W. Choong Foong, PhDMary Govoni, RDA, RDH
Derek HeinTimothy Kosinski, MS, DDS
Glenn LombardiSusan Maples, DDSAlan Mead, DDS
Kenneth Myers, DDSWilliam Nudera, DDS, MsChristopher Smiley, DDS
Jon Suzuki, DDS, PhD, MBADomenica Sweier, DDS, PhD
Anastasia Turchetti, RDHStephen Ura, DDS
Kelli VrlaDaniel Ward, DDS
Plus keynote speakerCONNIE PODESTA
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I selected ProAssurance because they stand behind my good dentistry. In spite of the maelstrom, I am protected, respected, and heard.
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Your practice depends on the individualized service you provide each and every client. So does ours.With extensive hands-on experience in the healthcare industry, our team focuses on the financial and operational challenges you face everyday. We are committed to providing industry-specific expertise relevant to you, without compromising your patient focus.
For more information please visit BeeneGarter.com or contact Brian LaFrenier at (616) 235-5200.
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For information contact Lori Kleinfelt or Andrea Sundermann at 800-589-2632 or via email at [email protected].
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201316
T E C H N I C A L L Y S P E A K I N G
n each WMDDS Bulletin I will be fielding your questions
about technology, its place in the dental practice, and beyond.
Send your questions to [email protected] and
I’ll answer them on my blog, facebook, and in each Bulletin.
I’m ready for a new computer. Windows 7 or Windows 8?My answer: Windows 7. Why? Windows 7 is stable, reli-
able, and considered to be the industry standard right now.
Support for Windows XP finally ended (and XP was released
12 years ago) so there is plenty of life left in Windows 7.
Now, Windows 8 is very cool and may someday become the
standard, but it may also suffer the fate of Vista and lead
a very troubled and short life. It’s too early to say at this
point. However, none of that matters nearly as much as
compatibility.
As you know, each of your software and hardware ven-
dors specify system requirements that your computers must
abide by in order to successfully use their product. Eaglesoft,
Dentrix, Softdent, Dexis, Tigerview, etc.… all have these
requirements – and guess what? Hardly any of them cur-
rently support Windows 8. How fast will that change? Good
question, that’s kind of like asking how long it will be before
Dentrix or Eaglesoft put any of the changes you’ve undoubt-
edly requested into their next update. Because we can’t pre-
dict or influence how fast and in what direction these vendors
move, Windows 7 is the safe bet for now.
Consider this as well: Windows 8 is basically brand new.
Remember back to one of the times you did your Practice
Management Software version update right away. Were there
bugs? Was it a headache? How long did it take before every-
thing worked the way you wanted to again? My approach is
that it just isn’t worth the hassle of being a first adopter. Sure,
Windows 8 has been tested as extensively as possible prior to
releasing to the public, but the best test of all (with any prod-
uct) is to release it to the public and see what happens. This
is why we have service packs and patches and such, to fix all
of the problems the first adopters were kind enough to find.
Someone has to be the first adopter, but I’d rather it not be
me or you.
Let’s be fair…Windows 8 is initially showing to have
great potential. I myself have it installed on my laptop in a
virtual machine environment and I have had no problems
with it. The interface is considerably different but in general
can be navigated by someone who can find their way around
Windows 7. I do think it’s going to take off in the next few
years, especially if the tablet market supports it.
Speaking of tablets, another plus for Windows 8 is its
interface for touchscreen monitors, laptops, or tablets.
Touchscreens on Windows 7 is a nice idea and works OK,
but Windows 8 is built for it. It’s more like using an ipad
but on your computer, it is just so much more intuitive
than Windows 7 for the touchscreen user. I am very excited
to someday use Windows 8 with touchscreens, navigating
between my 5 monitors (yes I’m that geeky) will be easier
when I can just touch the spot I want to go to rather than
mousing and mousing and mousing to get there. If you’ve
seen the Matrix or Avatar, those touch screen interfaces are
what I envision Windows 8 doing for the PC; it truly could
be a game changer. I also see these Windows 8 tablets as soon
being an answer to the demand for tablets in Dental Practices.
Notice I did say soon, we still have to wait on our good old
vendors to become Windows 8 compatible.
But Greg, what if I’m not going to use it in my practice at
all and just want to use it at home? I’ve pondered this myself,
which is why I have it running in a virtual machine on my
Windows 7 computer. If you like to tinker and enjoy the
adventure of new adventures, go for it! To keep a stable and
reliable Windows 7 computer intact, install Windows 8 in a
virtual environment or as a dual boot option. Then you get
the best of both worlds! For those of you who are perfectly
happy to let us curious souls figure it all out, keep enjoying
Windows 7, and your free time.
Windows 7 or 8?Submitted by Greg Feutz, President, DDS Integration
Greg Feutz is President of
DDS Integration, a
Grand Rapids based dental
technology company.
I
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 17
T E C H N I C A L L Y S P E A K I N G
What are your thoughts?Comment on our blog or facebook article. We’d love to hear
your opinions on Windows 7 vs. 8 or any other topic. If you
have tried out Windows 8, share your experience. We’re
excited to see what other people think!
Facebook: facebook.com/ddsintegration
Blog: ddsintegration.com/blog
The PoinTs of LighT ProjecT
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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201318 HANC Ad for the Bulletin 2/13/13 Size: 7.5” wide x 3.25” high (One-third Horizontal) 1213-9813
Good Ideas for Dental Practices
Hungerford, Aldrin,Nichols & Carter, P.C.C P A S A N D C O N S U L T A N T S
Where Good Ideas Add Up.™
Good Ideain a series of 15
When it comes to building your practice,
experience matters. Our understanding
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provide services and expertise beyond the scope of most
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#5“ Is your practice attractive to new associates?
Will they earn enough to aff ord the payments to you and/or the bank? When it is time for you to bring in an associate, analysis should be done to answer these questions.”
For 14 more Good Ideas from Hungerford, please email Rick Chrisman at [email protected], or call Rick at (616) 949-3200.
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Why all the Fuss about Airways and Faces? John Mew knew he changed faces. We now know he changed much more than that. Join us as physicians from the medical and dental community come together to discuss the implications of a compromised airway in children, and the impact that Biobloc Orthotropics® has on long term health as well as esthetics. ! Speakers include: John Mew, Michael Mew, Michael Gelb, DDS, Allen Moses, DDS ( inventor of ‘the Moses” appliance for snoring and OSA), Stephen Sheldon, DO ( pediatric sleep medicine),Phil Losavio, MD- ENT, William Hang, DDS, Christine Mills, BS, John Flutter, DDS, Bertrand da Silva, MD
Fourfold increase in airway
Be InspiredMay 2-4, 2013
Allerton Hotel- Downtown Chicago
Pre-symposium Thurs. 1-5 pm Dentists: $190.00 Staff: $45.00
Main Symposium Fri. & Sat. 8-5pm Dentists: $1115.00 Staff: $375.00Continental Breakfast and Lunch included Fri. & Sat. Banquet Fri. evening included
Call the office of Karen O’Rourke, DDS for more information and
registration details. (616)455-7930
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 19
MemberGet AMember
Building the future of our profession … together!
Share why you belong to the #1 organization representing all dentists.
As an active member, you know first-hand the value of a strong ADA — greater recognition for the profession, more resources for members, and a louder voice in Washington and across the country.
Most ADA members say they would recommend membership to colleagues. Now, here’s your chance!
ADA Member-Get-A-Member
Any ADA member dentist is eligible to participate in the 2013 ADA Member-Get-A-Member Campaign.
With your help:
• The ADA benefits by being able to represent another member dentist.
• The new member you recruit benefits by taking advantage of all membership has to offer.
• You benefit by strengthening the ADA and sharing the value of membership with another colleague — plus there are incentives and prizes for recruiters! For details visit ADA.org/MGAM.
Recruiting is Rewarding
You will be rewarded with a $100 American Express gift card for each new, active member you recruit (up to five members or $500 in American Express gift cards)! Or you may decline the incentive and ADA will contribute $100 to the ADA Foundation. Please see Campaign Rules for full details at ADA.org/MGAM.
Participate in the 2013 Member-Get-a-Member Campaign and help build the future of our profession!
Don’t Delay! The ADA Member-Get-A-Member campaign runs through September 30, 2013. For resources to assist your recruiting efforts, plus complete guidelines and rules visit ADA.org/MGAM, send an email to [email protected] or call the ADA Member Service Center at 800.621.8099.
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201320
Do You Know What Your Dental Practice Is Worth?Submitted by Richard L. Chrisman, CPA MSTHungerford, Aldrin, Nichols & Carter, PC
P R A C T I C E M A N A G E M E N T
nyone who has ever bought or sold a dental prac-
tice knows that buyers and sellers often have a very
different perspective on what a practice is worth.
A seller typically believes that his/her practice is worth more
than it really is. Meanwhile, the buyer is looking for a bargain.
Since a sale cannot occur until a purchase price is agreed to,
both parties are often motivated to find a number that is fair
to everyone.
Unfortunately, there is no standardized generally accepted
method for valuing a dental practice. There is no rule
of thumb that enables someone to determine a fair value by
simply looking at a few numbers and making a calculation.
There is no “right” or “easy” way.
The reality is – determining a fair value of a dental practice
is a difficult task with many complexities. There are many
objective and subjective factors that need to be considered.
When a practice valuation is necessary, it is a good idea to get
a valuation expert involved. An expert knows what informa-
tion to look at and how to interpret it.
Common valuation methodsEvery practice is unique. The valuation method that should
be used to arrive at a fair value will depend on the facts and
circumstances of the particular practice. Although there
are many methods used to value a dental practice, most
approaches tend to fall into one of three categories:
1. Asset Based – This method calculates the value of the
assets of the practice being sold. This is often a good place
to start. It gives you an idea of what the cost would be
to start up a similar practice by purchasing the necessary
assets. The shortcoming of this method is that the income
and cash flow of the practice are not considered.
2. Market Comparison – This method identifies similar
practices that have been sold and applies certain ratios of
those recent practice sales to the practice being valued.
This is like determining the value of a house by looking at
what similar houses have sold for.
3. Income/Cash Flow Based – This method identifies the
cash flow being generated by the practice, and then the
cash flow is either capitalized, discounted or multiplied.
In most situations the experts tend to favor the Income/Cash
Flow Based approach because it recognizes the components
that are critical to the ongoing success of the practice. This
method will enable the buyer to purchase a practice for a price
that is based on the expected income and cash flows of that
particular practice. The buyer will also have a good under-
standing of his ability to make any required loan payments to
the bank or prior owner.
Some factors that need to be considered when doing a valuationValuation experts will look at the following items among others
when preparing a valuation of a practice.
11. The results reported on recent financial statements and
tax returns.
12. A list of equipment and an estimate of its value.
13. The cost and age of leasehold improvements.
14. A production and collection report by each dentist
and hygienist.
15. An accounts receivable aging and collections report.
16. Any contracts that are in effect.
17. The total number of active patients.
18. The value of intangible assets.
19. The economic and industry outlook.
10. What is the reason for the owner to want to sell the
practice?
Other considerations when buying or selling a practiceIt is common for buyers and sellers to get emotionally
involved in the negotiation of the purchase price. However,
the devil is in the details. Most compromises on value are ulti-
mately achieved through the terms of the agreement. Besides
A
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 21
P R A C T I C E M A N A G E M E N T
the purchase price, there are two other major issues that need
to be agreed to: 1) What exactly is being purchased? i.e. stock
or assets, and 2) What are the payment terms of the sale? i.e.
cash and/or financing.
The cash flow and tax effects can vary significantly (to both
the buyer and seller) based on the terms. Therefore, to be sure
there are no surprises later, you should involve your CPA in
the negotiation of the details of the transaction.
If you are selling a practice, make sure you know 1) What
cash you are going to receive from the buyer, 2) When are
you going to receive it? 3) How much in taxes will be owed?
4) When will those taxes need to be paid? and 5) How much
cash will you ultimately end up with after the taxes are paid?
Make sure you understand and are comfortable with all those
numbers.
If you are buying a practice, make sure you understand
what risks you are taking, the purchase price is fair, and you
know where the cash flow is going to come from to meet the
terms of the purchase. The purchase of a practice will not go
well for the buyer if he overpays for it or the terms are not
manageable.
Richard L. Chrisman, CPA, MST is the Managing Shareholder of Hungerford,
Aldrin, Nichols and Carter PC, a Tax, Auditing and Business Consulting
firm with offices in Grand Rapids and Greenville, MI. The firm is celebrating
71 years of helping local businesses, including many area dental practices.
The passion to do more.
Our local bank proudly supports theWest Michigan Dental Community.
Born here.
Growing here.
Staying here.
LocationsCascade Rd at Spaulding - SE
Northland Dr at Plainfield - NE Monroe Ave at Louis - Downtown
Wilson Ave at 56th - SW
(616) 956-9030foundersbt.com
Member FDIC
Specialties Include:
• Custom designed deposits• Equipment financing• Financing of partner buy-in and
practice purchase
• Flexible loan payments• Practice start-up loans• Real Estate Financing• Working Capital Lines of Credit
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201322
C L A S S I F I E D A D S
Established Dental Office Space –
2003 Burton SE (between Breton and
Plymouth). End unit with 720 sq. ft.
and a full basement, on-site parking,
adjacent 3 spaces occupied by estab-
lished dentists. Great traffic counts on
Burton in an established residential
area. Call Bruce at 942.9492.
Seeking Employment – General
dentist with several years of experi-
ence seeking part-time employment in
the West Michigan and surrounding
areas. Proficient in all areas of general
dentistry. A team player. Please reply to
Dental Office for Lease – Time to
move up? Busy northeast area dental
suite at 1750 Grand Ridge Ct. NE,
3295 SF, ten-year old modern dental
office available. 3 pvt ops, 4 chair bay
area, plumbed for nitrous, air, water,
power and vacuum, lab, x-ray, staff
area, pvt. office, reception, storage
available. Former pedo practice
obtainable Jan. 1st 2011. Contact
Dr. John Monticello 616.364.1700 or
Associate position wanted – Newly
graduated dentist from UDM looking
for full time position as an associate
of progressive dental practice in
Grand Rapids and surrounding areas.
Please call 616.617.9725 or email
For Sale – Lab Master Foster Model
Trimmer, Model # MT115, like new
$600. Contact 616.949.7510.
Dental Office for Lease – with imme-
diate availability. Near the “medical
mile” on primary road with high traffic
count and super visibility. Has been
a dental office for over 40 years. Very
good lease terms/rates. Would make
awesome start-up or satellite. For more
info, email [email protected].
General Dentist – Looking to purchase
a practice or pursue transition in
Grand Rapids area. Three years of
experience. Please email to:
Associate Position Wanted – Fourth-
year at University of Florida COD
and Michigan native seeking full-time
The classified ad rate is $10.00 up to and including 30 words; additional words 15¢ each. Space permitting, WMDDS members may
place ads free of charge as a membership service. Ads should be submitted in writing and sent with payment to Elaine Fleming,
WMDDS, 511-F Waters Building, Grand Rapids, MI 49503. Telephone numbers and hyphenations count as two words, abbrevia-
tions count as one word. Ads received after the first of the month prior to publication may appear in the following issue.
associate level opportunities in greater
Grand Rapids area beginning summer/
fall 2013. [email protected] or
248.568.0839.
Seeking employment – General den-
tist with eight years of experience
seeking part-time employment in
West Michigan area. Enjoys practicing
most areas of dentistry. Please email:
Dentist Needed – Full-time or part-
time at State of Michigan Correctional
Facility in Ionia, MI. Avoid headaches
of private practice. For information
please call Ken or Richard at
517.321.9313.
Ottawa County Health Department is currently in the process of recruiting a
part-time dentist to provide services on the county’s 40 foot, state-of-the-art
“Miles of Smiles” Mobile Dental Unit. The mobile unit provides compre-
hensive dental services at schools and Head Start Centers throughout Ottawa
County (Grand Haven, Holland, etc.). Please see attachment for additional
information regarding this exciting career opportunity!
Employment will involve 1-2 days per week (6 hours/day). Competitive wage.
If you are interested in this position, please e-mail a resume to:
Debra J. Bassett R.D.H., B.H.S.
Oral Health Team Supervisor
Ottawa County Health Department
12251 James Street, Suite 400
Holland, MI 49424
We look forward to hearing from you!
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2013 23
C L A S S I F I E D A D S
Beautiful, Professional Suite Available for Sale/Lease – N.W.
Michigan, lower peninsula, in a grow-
ing community. Great opportunity for
any dentist, with many extras. Ideal
location, safe and serene, for any
family. World-class cultural events,
restaurants and attractions nearby.
Sporting adventures abound.
Turn-key. Let’s talk. Call 231.313.8407
Exciting Opportunities – for dentists
to provide children with dental care
in Grand Rapids area schools. No
evenings or weekends. Apply at
smileprograms.com or call Tracey at
888.833.8441, ext. 126.
Kavo Handpieces for Sale –
6000B have 5 at $400/handpiece,
6500B have 6 at $400/ handpiece,
647B have 8 at $200/handpiece,
640B have 2 at $200/handpiece,
649B have 2 at $200/handpiece.
Call 616-453-6323.
For Sale – Kavo GentleRay 980 Diode
LASER. Specializes in management
of all soft tissue procedures such as
gingival troughing, aphthous ulcer
treatment, and perio pocket treatment
as well as bleaching. Features a large,
bright touch screen with built in clini-
cial tutorials for easy practice integra-
tion. Like new, used approximately
15 times. Includes ALL accessories
needed for immediate use including
protective eyewear for doctor, patient
and assistant and 3 tips for handpiece.
Also includes rolling cart for portabil-
ity. Please call or email for details/
photos. Phone 616.606.3263, or email
[email protected]. Purchased
for approximately $10K. Asking
$5,500/obo.
Graduating dental student seeking
associate position in Grand Rapids or
surrounding areas beginning in early
June. Among the top performers of
graduating class and eager to bring
strong work ethic, collaborative nature
and attention to detail to your practice.
Business-minded professional and
committed to providing exceptional
dental care. Please contact Katelyn
Van Slyke at [email protected] or
616.540.6369.
Dental Dreams desires motivated,
quality-oriented associate dentists
for its offices in Muskegon, Saginaw
and Flint. We focus on providing the
entire family superior quality dentistry
in a modern technologically advanced
setting with experienced support staff.
Because we understand the tremendous
value of our associate dentists, we
ensure that their compensation pack-
age is amongst the best. Our average
colleague dentist earns on average
$230,000 per year plus benefits.
Please contact Danielle Tharp at
313.274.4524 or email
The Bulletin wishes to thank our valued
advertisers who support organized
dentistry by helping to defray the cost
of printing and mailing.
Advertising in the Bulletin is seen
by over 90% of the dentists in the
West Michigan District. This includes
five of the fastest growing counties
in the state: Kent, Ottawa, Ionia,
Montcalm and Mecosta.
For information on advertising rates,
call Elaine Fleming, WMDDS Executive
Secretary at 234-5605. Target your Market
– advertise in the Bulletin!
Beene Garter ......................................14
DDS Integration .... outside back cover
Davis Dental
Laboratory ............... inside front cover
Founders Bank & Trust ....................21
Great Lakes Financial Insurance ......17
Henry Schein ............inside back cover
Hungerford, Aldrin, Nichols &
Carter, PC ..........................................18
Keystone Pharmacy ..........................14
MDA IFG ...........................................11
ProAssurance.....................................13
A D V E R T I S E R I N D E X
WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 201324
Lunch & Learn with Hungerford Valuation
1. Are you an associate with plans to buy a practice? 2. Will you use the sale of your practice to fund your retirement? 3. Do you have an exit strategy or succession plan? 4. Have you considered bringing in an associate?
Practice valuation is more than just a rule of thumb. Hungerford Valuation will present an overview of dental practice valuation techniques. We will explore why practice value is important as well as how practices are valued. Participants will leave with an understanding of basic valuation concepts and tips you can use to improve the value of your practice. Please join Kerry A. Bean, CPA/ABV and Brandon Finnie of Hungerford Valuation for this free informative session. Kerry and Brandon have valued hundreds of privately-held businesses including dental practices. Topics of discussion will include:
Why It’s Important to Understand Your Practice’s Value • Succession Planning • Buy/Sell Purposes
Practice Valuation Overview Tips to Improve Your Practice’s Value
When: Friday, April 19th, 11:30 a.m. to 1:00 p.m. Agenda: 11:30-12:00 p.m. Registration and Lunch 12:00-1:00 p.m. Presentation Where: Hungerford, Aldrin, Nichols & Carter, PC – Cripps Training Room 2910 Lucerne Drive SE Grand Rapids, MI 49546
Register now by calling Sharon Whipple at HANC 616-949-3200 or via email at [email protected]. Reservations are required.
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WEST MICHIGAN DENTAL SOCIETY
511-F Waters Building
Grand Rapids, MI 49503
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PAIDGRAND RAPIDS, MI
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