Why did Henry Schein’s Dentrix Dental Practice Management Software division sell its Imaging component (digital x-rays and photography) to Danaher’s Dexis division? Dentists who purchased Dentrix from Schein now have to deal with two multi-billion dollar companies (Schein and Danaher) for Dentrix upgrades and support. A Dentrix source said that the cost for the upgrades and support, now split between the companies, will be comparable to prior experience with just Schein. But still the question is why? It seems anti-competitive for the end user, and in this era of emphasis on Electronic Medical Records (EMR), we need to know. I personally believe in EMR but this development does not make me want to recommend Dentrix to my students.

Read the Wall Street Journal article.

This afternoon I viewed a patient who was in for an implant placement on #9. The 25 year old female had the tooth extracted over 10 years ago because the tooth would not erupt and was not able to be orthodontically erupted. Prior to the implant surgery a bacterial culture was taken because of a few severe localized pockets on select molars and premolars, which may be indicative of post-juvenile periodontitis. (See Image #1) The bacterial culture was taken by placing paper points into the facial and lingual sites of each deep pocket location for a few seconds, and then placed into the culture solution. The culture will be sent to an oral microbiology lab for testing and further treatment will be decided on then.

The patient received profound anesthesia prior to the implant placement. The size and location of the edentulous area indicated the use of a 3.5mm x 12mm implant in the area of #9. (See Image #2 and #3) Radiographs were taken to verify the placement and seating of the implant and healing abutment and sutures were placed to reapproximate the tissues for successful healing. The patient has been wearing a flipper for approximately 8 years and therefore the seating of the flipper post-surgery was confirmed and no adjustments were necessary.

N.S., New York University College of Dentistry

A 21 year old female presented as a first time patient to the dental office. Her chief complaint was she was unhappy with smile, specifically the position of teeth #6, 10 and 27. Both upper and lower arches were severely crowded. Another dentist had suggested braces as the only treatment but the patient absolutely refused it as a treatment option. It was explained that orthodontics was the best treatment option, but not the only one.

For teeth #6 and 10, alternative treatment options to address the patient’s chief complaint were crowns, veneers or cosmetic bondings. All benefits and risks were explained. The patient’s finances limited her options to cosmetic bonding. Due to the labial flare of #6 and 10, sculpting (reshaping) the teeth would require removal of a significant amount of tooth structure. This would lead to nerve exposure so root canal therapy was strongly planned.

On the lower arch tooth #27 was completely lingually displaced from the arch. There was no room for this tooth in the arch, so the only reasonable non-orthodontic treatment option was extraction of #27. On the day of the extraction the patient was anesthetized with 3.6cc of lidocaine, and the extraction was completed by an Oral Surgeon without complication. A simple chromic suture was placed to allow soft tissue approximation and healing by primary intention. The 1 week re-evaluation showed the area of #27 had epithelialized over the wound and healed properly. Treatment of the remaining minor crowding in the mandibular arch was not desired by the patient.

At the next visit, prophylactic root canal therapy on # 6 and 10 was completed by the endodontist. Tooth #6 was anesthetized with 1.7 cc Septocaine and isolated with rubber damn. Access was obtained, and the single canal found was instrumented to 25mm, obturated with gutta percha and cement, and temporized. Tooth #10 was anesthetized with 1.7 cc Septocaine and isolated with rubber damn. Access was obtained, and the single canal found was instrumented to 22mm, obturated with gutta percha and cement, and temporized.

During the following visit, bonding and sculpting of #6 and 10 began. Tooth #6 was completed by an NYU senior dental student, and tooth #10 was completed by a Columbia University senior dental student. No anesthesia was necessary, as the teeth were root canal treated. The temporary fillings on the lingual of #6 and 10 from endodontic access was removed and replaced with a permanent composite filling. The lingual surfaces were roughened with a bur to allow for better retention. Next, the labial surface of the teeth were etched, bonded and MIDLF surfaces were built incrementally with Herculite bonding shade A1. The facial surfaces of the teeth were sculpted, bringing the teeth back into the arch. The occlusion was adjusted as needed. The patient was satisfied with the cosmetic results.

During a followup visit the patient requested a few cosmetic adjustments. The facial surface of #10 was etched, bonded and built up with Herculite bonding shade A4 followed by a external layer of XL2 bonding cover shade. The final contours were sculpted and the occlusion was adjusted. The patient was satisfied with cosmetic results.

After acclimating to the cosmetic bonding on #10, the patient scheduled another visit for cosmetic bleaching of the surrounding teeth. The teeth were isolated with a liquid dam to protect the gingival tissue. Two rounds of bleaching at 10 minute intervals on both upper and lower arches were completed. Patient informed that some white spots are normal and will resolve with time as the color of the teeth settles. Patient was satisfied with the color. Tooth #6 facial composite bonding was adjusted to improve color and give uniformity to the facial surface. Tooth #6 was reduced 1mm facially, etched, bonded and 1mm increments of XL2 composite were added on the facial; Bonding was sculpted and the occlusion adjusted. Patient was satisfied with cosmetic result.

The patient was encouraged to return for any other dental work needed, regarding the cosmetic bonding done, or any future treatment. She was advised to avoid hard foods on teeth #6 and #10. In the future if financially possible, she was encouraged to have porcelain crowns placed on #6 and #10. She was very happy with the final outcome and less timid about smiling and showing off her new teeth. Overall the treatment was delivered in a satisfactory and timely manner.

N.D., New York University College of Dentistry

This afternoon I continued the treatment of a patient’s #3 PFM crown. The crown came back from the lab with a Kaitlyn Loop on the lingual side of it for floss to keep a better hold of the crown. The crown was tried in, margins and contacts were checked, and occlusion was adjusted. The patient was satisfied with the esthetics and fit of the crown and signed a consent form for final cementation. The crown was cemented in with RelyX cement and the Kaitlyn Loop was removed.

The patient then complained of a chipped filling on the lower left. The patient is not currently in any pain. Tooth #19 was examined and the restoration was chipped on the buccal portion of the occlusal surface. A periapical and bitewing radiograph was taken of tooth #19. A periapical pathology was seen on the mesial root as well as a widening of the periodontal ligament on the distal root. Caries was found on the distal portion of the tooth. There is a possible fracture on the mesial root. The patient was given the information and treatment options and will return at the next visit to further explore the treatment options for this tooth.

N.S., New York University College of Dentistry

Another logical step would be acquisition of the independent Category Leaders. Content trumps cookies.

Read the Wall Street Journal article.

The Center for Special Dentistry in NYC has created a health care model for academic and clinical dentistry that has been successful for over a decade. It is affiliated with both Columbia and NYU dental schools. The Obama administration may learn about it at www.NYCdentist.com/faculty. We’d be thrilled to help expand it nationally and include medicine.

Read the Wall Street Journal article.

I was thrilled to read this article today. Niche web sites can successfully compete against the titans because the content-creators are typically principals at these small firms and their business model may incorporate cost controls plus other means for revenue that gives them a competitive advantage. In addition, the traffic to a targeted website could arguably be as valuable to an advertiser as a titan with 100 – 1,000 the traffic.

At www.NYCdentist.com we are able to perform and photodocument multi-specialty cosmetic dentistry and get paid for it by the patients receiving the care. We are then able to anonymously publish case studies using this content. Our cost for content creation is therefore very low (no full time staff) and patient revenue supports the small cost of content creation which further increases new patient referrals. This positive feedback loop has profitably created the largest free dental content web business worldwide for over ten years. We also agree with this article that our traffic is steadily growing to a rate of 200,000 targeted monthly visitors for February 2009.

Roll-ups are expected in several more years. It will take that long for the titans to really understand this business model.

Read the Wall Street Journal article.